Economical revenue comes out of investing in CardiotomTM
A study made at Karolinska Universitetssjukhuset, Karolinska Institutet & KTH shows that substantial economical revenue comes out of investing in Cardiotom.
With two patients per day the investment pays itself in less than 18 month. Adolesco will see to that the customers of Cardiotom will get a professionally financing. A variety of possibilities exist. Everything from lease, lease and buy, pay per patient to cash.
A cost benefit analysis of the use of a mobile 3D-gamma camera for cardiac diagnosis
- a brief summary
Cardiotom is a mobile tomographic gamma camera developed and marketed by Adolesco AB.
M.E.E. Magnus Brunn in his master's thesis Analys av kostnadseffektivitet och vårdkedja vid införande av mobil gammakamera för hjärtdiagnostik presented a theoretical cost benefit analysis of using Cardiotom for the diagnosis of cardiac disorders in the emergency room or acute situation. The outcome of the study is very positive, but the study has it limitations, it is based on a review of the relevant literature, present care processes, statistics and interviews and the result is a theoretical model of how the 24/365 use of a mobile gamma camera in the acute situation can improve care and lower costs. The favourable results from his model study are now being verified by a clinical investigation, Mobile gamma camera in the emergency room as a gate keeper - better care for patients with chest pain at lower cost (SLL20060828). The clinical investigation is sponsored by the Karolinska University Hospital and the County of Stockholm and is expected to be completed during 2009/2010.
This is a very brief summary of Brunn's report:
Clinical background
Myocardial Perfusion Scintigraphy (MPS) has in several studies been shown to be the superior and most efficient method for the diagnosis as well as prognosis of ischemic heart disease [7]. Non-invasive MPS has shown a sensitivity for finding coronary vessel diseases of 96 % compared with 35 % for EKG. MPS can contrary to enzymatic markers detect or exclude ischemic regions and infarctions in the early acute phase [1, 7, 9] enabling an early decision on how to handle the patient. One example is Udelson's [16] investigation of the benefits of using MPS in the emergency room. His results are summarised in the table below:
| MPS strategy (%) | Normal strategy (%) | |
| Hospitalisation | 47,5 | 56,1 |
| ICU |
6,3 | 5,2 |
| A & E (accident and emergency) | 30,4 | 37,0 |
| After care - Cardiac Unit | 10,8 | 13,8 |
| Discharged | 52,6 | 44, |
After Udelson et al16
With MPS fewer patients were hospitalised and more could be sent home. The study clearly demonstrated that MPS reduces unnecessary hospitalisation without risks for patients suffering from ischemic heart disease.
Economical benefits
The results presented above indicate that the use of MPS can lead to substantial economical benefits. Costs associated with ischemic heart disease are, however, difficult to asses. The Empire study [17] estimates that the use of MPS results in a cost saving of around $ 448 per patient for a hospital with 1000 acute cardiac patients a year. Weissmann et. al. found that savings of $ 786 were possible through the use of MPS. Heller et. al. [22] found that savings of $ 4 258 per patient where possible.
These results and other show that large savings, with benefits to patient without loss of quality of care, are possible through the use of MPS. The spread in reported savings illustrates that exact measures are difficult to obtain and that actual savings will depend very much on how the implementation of MPS is carried out.
Implementation of MPS with Cardiotom
For the realisation of the benefits described above MPS must be available nearly 24/365. For this Cardiotom is well suited. Cardiotom does not need any installation and can be freely moved around as needed, the patient can be examined in a hospital bed and even be attached to life support equipment. Brunn developed the patient management model illustrated below as an example of how Cardiotom can be incorporated in the clinical routine:
The savings are substantial, investment in equipment and training costs are recovered already after 79 patients.
References and relevant literature
1. Kontos MC, Jesse RL, Schmidt KL, Ornato JP, Tatum JL, McCue M, Rossiter LF, Jurgensen M, Nicholson CS A comprehensive strategy for the evaluation and triage of the chest pain patient: A cost comparison study. Journal of Nuclear Cardiology 2003;10:284-90
2. . Rikshia årsrapport 2003
http://www.ucr.uu.se/rikshia/arsrapporter.htm
Scaar årsrapport 2004
http://www.ucr.uu.se/scaar/arsrapporter.html
3. Iwarson A, Karlsson BW, Herlitz J Myocardial infarction is diagnosed in every 20th case of acute chest pain. Good consistency between 2 emergency admission departments. Läkartidningen 1996 Maj 8;93(19):1830-2
4. Karlsson BW, Pettersson P, Ekvall HE, Herlitz J, Hjalmarson A Patients admitted to the emergency room with symptoms indicative of an acute mycardial infarction. Journal of Intern Med. 1991 Sep; 230(3):251-8
5. Jacobson B Medicin och teknik Studentlitteratur1995 ISBN 91-630-3338-0
6. Persson M Cardiotom, Development of a mobile Tomographic gamma camera based on ectomography Department of medical laboratory sciences and technology, Division of medical engineering, KI Sweden ISBN 91-628-5009-1
7. Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ Harbinson M, Kelion D, Al-Mohammad A, Prvulovich, Shaw LJ, Tweddel AC Myocardial perfusion scintigraphy: the evidence. European journal of nuclear medicine and molecular imaging 2004;31(2):261-291
8. Svensson L, Isaksson L, Axelsson C, Nordlander R Herlitz J Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome. Coronary Artery Disease 2003;14:225-231
9. Bilodeau L, Theroux P, Gregoire J, Gagnon D, Arsenault A Technetium-99m sestamibi tomography in patients with spontaneous chest pain: correlations with clinical, electrocardiographic and angiographic findings.
J Am Coll Cardiol. 1991 Dec;18 (7):1684-91.
10. Lee TH, Cook EF, Wesberg M, Sargent RK, Wilson C, Goldman L Acute chest pain in the emergency room. Identification and examination of low-risk patients. Arch Intern Med. 1985;145(1):65-9
11.Diderholm E, Andrén B, Frostfeldt G, Genberg M, Jernberg T, Lagerqvist B, Lindahl B, Wallentin L Effects of an early invasive strategy on ischemia and exercise tolerance among patients with unstable coronary artery disease. Am J Med. 2003;115:606-612
12. Udelson JE, Flint EJ Radionuclide imaging in riskassessment after acute coronary syndromes. Heart 2004;90:v16-25
13. Kontos MC, Jesse RL, Schmidt KL, Ornato JP, Tatum JL Value of acute rest sestamibi perfusion imageing for evaluation of patients admitted to the emergency department with chest pain. Journal of American College of Cardiology 1997;30:976-82
14.Hilton TC, Thompson RC, Fulmer H, Abuan T, Stowers SA Ninety-day follow-up of patients in the emergency department with chest pain who undergo initial SPECT scintigraphy with technetium 99m-labeled sestamibi. Journal of Nuclear Medicine 1996;3(4):308-11
15. Hilton TC, Thompson RC, Williams HJ, Saylors R, Fulmer H, Stowers SA Technetium-99m sestamibi myocardial perfusion imaging in the emergency room evaluation of chest pain. Journal of American College of Cardiology 1994;23(5):1016-22
16 Udelson JE, Beshansky JR, Ballin DS, Feldman JA, Griffith JL, Heller GV, Hendel RC, Pope JH, Ruthazer R, Spiegler EJ, Woolard RH, Handler J, Selker HP Myocardial Perfusion Image for Evaluation and Triage of Patiens With Suspecte4d Acute Cardiac Ischemia JAMA 2002- vol 288, No.21
17. Underwood SR, Godman B, Salyani S, Ogle JR, ELL PJ Economics of myocardial perfusion imaging in Europé- The Empire study European Heart Journal 1999;20:157-166
18 Janzon M, Levin LÅ, Swahn E Cost-effectiveness of an invasive strategy in unstable coronary artery disease. European heart Journal 2002; 23:31-40
19. Socialstyrelsen Epidemiologiskt centrum
http://www.sos.se/EPC/cpk/vad_DRG.htm#Kort
20. Socialstyrelsen Epidemiologiskt centrum http://www.sos.se/epc/cpk/konf03/GrundKPP.pdf
21. Weissman IA, Dickinson CZ, Dworkin HJ, O´Neill WW, Juni JE Cost-effectivness of myocardial perfusion imaging with SPECT in the emergency department evaluation of patients with unexplained chest pain. Radiology 1996;199(2):353-7
22. Heller GV, Stowers SA, Hendel RC, Herman SD, Daher E, Ahlberg AW, Baron JM, Mendes CF, Rizzo JA, Wackers FJ Clinical Value of acute rest technetium-99m Tetrofosmin tomograpic myocardial perfusion imaging in patients with acute chest pain and nondiagnostic electrocardiograms. Journal of American College of Cardiology 1998;31:1011-7
23. Stowers SA, Eisenstein EL, Th Wackers FJ, Berman DS, Blackshear JL, Jones AD Jr, Szymanski TJ Jr, Lam LC, Simons TA, Natale D, Paige KA, Wagner GS.
An economic analysis of an aggressive diagnostic strategy with single photon emission computed tomography myocardial perfusion imaging and early exercise stress testing in emergency department patients who present with chest pain but nondiagnostic electrocardiograms: results from a randomized trial.
Ann Emerg Med. 2000 Jan;35(1):17-25.
24. Mark DB, Shaw LJ, Lauer MS, O'Malley PG, Heidenreich P 34th Bethesda Conference: Task force #5--Is atherosclerosis imaging cost effective?
J Am Coll Cardiol. 2003 Jun 4;41(11):1906-17.
25.Kim C, Kwok YS, Saha S, Redberg RF Diagnosis of suspected coronary artery disease in women: a cost-effectiveness analysis Am Heart J 1999 Jun;137(6):983-4
26. Socialstyrelsens riktlinjer för hjärtsjukvård 2004 Beslutsstöd för prioriteringar
ISBN 91-7201-875-5, Artikelnr: 2004-102-2 Sättning: Intellecta Communication AB
Tryck: Bergslagens Grafiska AB, Lindesberg, juni 2004
27. WeAidU, www.WeAidU.com 2005-12-21
28. Strål skydds institutet SSI rapport: 2004:16 December 2004
ISSN 0282-4434