Invasive management does not appear to be associated with increased cost in the Australian setting

Modern clinical trial evidence supports the use of early invasive management for patients presenting with non-ST segment elevation acute coronary syndrome (NSTE-ACS). However, certain sub-populations such as the elderly are frequently managed conservatively despite this data. Potentially, concerns regarding the appropriate use of scarce resources may contribute to this bias.We sought to define the incremental adjusted-cost of invasive management in the population of NSTE-ACS patients. We conducted an audit of consecutive NSTE-ACS patients presenting to Flinders Medical Centre, Cardiac Care Unit between July 2002 and July 2003. Early invasive management was defined as angiography occurring within 4 days of presentation. Trained nursing staff abstracted clinical and procedural data. In-hospital cost data was derived from the Trendstar hospital-costing system. Total cost was log-transformed to satisfy Gaussian assumptions and the incremental cost of invasive management was assessed by linear regression. A total of 414 patients were included in the analysis. Patients undergoing invasive management were associated with a substantially shorter length of stay (4 days (i.q.r.3–6 days) versus 9 days (i.q.r.7–14 days), p = 0.001). Univariate analysis shows an incremental cost saving of −$1320 (95% C.I.: −$243 to −$2037), p = 0.022 per admission. After adjusting for age > 75 years, diabetes, gender, killip class and hypertension, this cost saving remained significant (−$2363, 95% C.I. −$41 to −$3580, p < 0.049). The early invasive management of NSTE-ACS patients does not appear to result in increased cost. While other clinical factors may need to be considered, resources alone should not be a reason to withhold therapy.