Cost implications of implementing NICE guideline on chest pain in rapid access chest pain clinics: an audit and cost analysis.

Background: Implementing the recently published National Institute for Health and Clinical Excellence (NICE) clinical guideline on chest pain (CG95) in rapid access chest pain clinics (RACPCs) could significantly impact on overall cost, while introducing new technology like cardiac computed tomography (CT) scanning. With the National Health Service (NHS) under pressure to make £20 billion savings, applying CG95 in RACPCs could be challenging. An audit enabled us to assess the cost implications.

Methods: A retrospective audit was performed of 204 consecutive cases attending Croydon RACPC from 13 July to 21 September 2010, on risk factors, demographics and planned first-line investigations. CG95 and three alternative strategies were mapped on the sample, and the estimated cost and volume of first-line investigations were compared with actual RACPC activities and costs.

Results: Application of CG95 resulted in significant increases in cost and volume of functional testing, cardiac CT scan angiography and invasive coronary angiography, with 42-43% overall cost increases. The application of three alternative strategies resulted in annual cost increases ranging from 0.1 to 33%. An alternative cost analysis showed annual savings of up to 24%.

Conclusions: Implementing NICE CG95 can significantly increase the cost of RACPCs but alternative strategies could enable the introduction of new technology without significant cost increases and even significant savings.