Economic evaluation of applying the Canadian Syncope Risk Score in an Australian emergency department

• Published in: Emergency medicine Australasia 2023-06, Vol.35 (3), p.427-433
• Main Authors: Brain, David, Yan, Alan, Morel, Doug, Ballard, Emma, Hunter, Jonathan, Hocking, Julia, Chan, Jason
• Format: Article
• Language: English
• Subjects: Australia; Cost-Benefit Analysis; cost‐effectiveness; economic evaluation; emergency; Emergency Service, Hospital; health services research; Humans; Prospective Studies; Risk Assessment; Risk Factors; syncope; Syncope - diagnosis
• ISSN: 1742-6731; 1742-6723
• DOI: 10.1111/1742-6723.14139

Objective To evaluate the Canadian Syncope Risk Score (CSRS) in syncope patients presenting to the ED from an economic perspective, using very‐low and low‐risk patients (CSRS −3 to 0) as a threshold for avoiding hospital admissions. Methods A decision‐analytic model, specifically a decision‐tree, was developed to evaluate application of the CSRS. A hypothetical cohort of 1000 patients was modelled based on characteristics and outcome of patients enrolled in a clinical validation study performed alongside this evaluation. Several analytic based approaches were used to handle model outputs and uncertainties. Results For a cohort of 1000 patients, applying the CSRS was associated with 169 less inpatient admissions from the ED, when compared to usual care. There was also a cost‐saving of $8255 per admitted patient, when the CSRS was applied, compared to usual care. Adopting the CSRS was the optimal approach in all scenario analyses and was robust to changes in model parameters. More than three‐quarters (78.6%) of all model simulations showed that applying the CSRS is a cost‐saving approach to managing syncope. There was high confidence in all results, with the approach using the CSRS reducing the costs and number of syncope‐related hospital admissions. Conclusions Compared to usual care, applying the CSRS appeared as a cost‐effective strategy. This new evidence will help decision‐makers choose cost‐effective approaches for the management of patients presenting to the ED with syncope, as they search for efficient ways to maximise health gain from a finite budget. The timely management of patients presenting to the ED with syncope has long been a challenge and traditionally presenting patients are managed conservatively due to concern that they may have a serious underlying issue. Given the resource‐constrained healthcare environment, we believe that this study provides useful and pragmatic evidence for decision‐makers who are interested in maximising health gain per dollar spent. Compared to usual care, applying the Canadian Syncope Risk Score appeared to be a cost‐effective way to manage patients presenting to ED with syncope.