Cost Effectiveness of ED Imaging Strategies for Diagnosing COVID-19

Systematic ultra-low-dose chest computed tomography (CT) appeared the most cost-effective of four imaging strategies for triaging patients with suspected COVID-19 in the emergency department in the absence of point-of-care detection, according to study findings published in Clinical Microbiology and Infection.

“Emergency departments were on the front line for the diagnostic workup of patients with COVID-19 like symptoms during the first wave. Chest imaging was the key to rapidly identifying COVID-19 before administering rapid reverse-transcriptase polymerase chain reaction (RT-PCR), which was time-consuming,” wrote a research team from France. “The objective of our study was to compare the costs and organizational benefits of triage strategies in the emergency department during the first wave of the COVID-19 pandemic.”

The retrospective study included 3712 consecutive patients with COVID-19 symptoms at five emergency departments in France between March 9, 2020, and April 8, 2020. Researchers looked at length of stay in the emergency department and costs associated with four imaging strategies (chest radiography, chest CT scan in the presence of respiratory symptoms, systematic ultra-low-dose chest CT, and no systematic imaging) to compare their cost-effectiveness.

Chest radiography and RT-PCR with no systematic imaging were the least effective strategies when it came to time, according to the study. Emergency department stays averaged 10.9 hours with no systematic imaging and 10.7 hours with chest radiography.

Compared with chest radiography, systematic ultra-low-dose chest CT was the more cost-effective strategy, the study showed. With an average emergency department stay of 6.89 hours and cost of €3646, systematic ultra-low-dose chest CT shortened length of stay by nearly 4 hours, at a cost increase of €98 per patient.

Meanwhile, chest CT in the presence of respiratory symptoms provided a gain of 37 minutes compared with systematic ultra-low-dose chest CT, but it did so at an added cost of €718 per patient.

“Given a willingness to pay [threshold] of €325 per hour gained in the emergency department, there was a 70% probability that systematic ultra-low-dose chest CT was the most cost-effective strategy,” researchers reported.

Reference:
Kepka S, Zarca K, Viglino D, et al. Imaging strategies used in emergency departments for the diagnostic workup of COVID-19 patients during the first wave of the pandemic: a multicenter retrospective cost-effectiveness analysis. Clin Microbiol Infect. Published online June 20, 2022. doi:10.1016/j.cmi.2022.05.036