Is a chest pain observation unit likely to be cost saving in a British hospital?

Background-Studies from the United States (US) suggest that using a chest p ain observation unit (CPOU) saves from $567 to $2030 per case compared with hospital admission. These savings will only be reproduced in the United Ki ngdom (UK) if the cost of routine hospital admission is similar. This study aimed to review current practice to determine the proportion of patients s uitable for CPOU evaluation, the cost per case of routine admission and com pare this with control groups in US studies. Methods-300 patients were randomly selected from those admitted with chest pain between January and June 1998. Two independent observers reviewed the case notes to determine who would have been suitable for CPOU management. R esource use of those selected was then determined. Results-Notes were retreived for 285 patients. A total of 106 (37.2%) were suitable for CPOU care. Mean length of stay was 51 hours (median 24). Only two patients were admitted to the coronary care unit. Interventional cardio logy was limited to two angiograms, one angioplasty and one bypass graft. E stimated mean cost per patient was pound 458 ($733) with interventional car diology included, pound 356 ($570) without. Conclusion-Potential exists for the introduction of CPOU care to reduce hea lth service costs in the UK. However, the magnitude of cost savings demonst rated in US studies were achieved by comparison to relatively high inpatien t costs and determined. Results-Notes were retrieved for 285 patients. A to tal of 106 (37.2%) were should not be extrapolated. Economic evaluation of the CPOU should be repeated in the UK. The inclusion interventional cardiol ogy costs is an important determinant of cost effectiveness.