Medical malpractice and litigation: What does this mean for the cost-effectiveness of diagnosing chest pain?

Priest, V. L., Scuffham, P. A. and Marwick, T. (2010). Medical malpractice and litigation: What does this mean for the cost-effectiveness of diagnosing chest pain?. In: ISPOR 4th Asia-Pacific Conference Research Abstracts. ISPOR 4th Asia-Pacific Conference, Phuket, Thailand, (A525-A525). 5-7 September 2010. doi:10.1111/j.1524-4733.2010.00793_3.x


Author Priest, V. L.
Scuffham, P. A.
Marwick, T.
Title of paper Medical malpractice and litigation: What does this mean for the cost-effectiveness of diagnosing chest pain?
Conference name ISPOR 4th Asia-Pacific Conference
Conference location Phuket, Thailand
Conference dates 5-7 September 2010
Proceedings title ISPOR 4th Asia-Pacific Conference Research Abstracts   Check publisher's open access policy
Journal name Value in Health   Check publisher's open access policy
Place of Publication Hoboken, NJ, U.S.A.
Publisher Wiley-Blackwell Publishing
Publication Year 2010
Sub-type Poster
DOI 10.1111/j.1524-4733.2010.00793_3.x
ISSN 1098-3015
1524-4733
Volume 13
Issue 7
Start page A525
End page A525
Total pages 1
Language eng
Formatted Abstract/Summary
Objectives: To determine the effect of including the costs and risks of medical negligence claims on the results of a cost-utility model of diagnostic strategies for patients with chest pain presenting at the Emergency Room. Coronary computed tomography (CT) has been proposed as an initial screening technique for patients at low risk of coronary artery disease, because it may allow earlier discharge and cost savings compared with stress-based tests such as exercise single-photon emitting computed tomography (SPECT) or exercise echocardiography (E x E).

Methods:
A decision-analytic model was designed to calculate the expected costs and health outcomes at 12 months for patients at low risk of coronary artery disease presenting at the Emergency Room with chest pain. Published data was used to predict the accuracies of the diagnostic tests. Costs were calculated from the perspective of the Australian health system, and a rate (30%) and cost of litigation ($160,000) was included for false negative diagnoses that incurred an event within the time frame.

Results:
ExE was the least costly strategy in the base case analysis. The results are sensitive to changes in the cost and likelihood of litigation, because these costs are high relative to the other costs in the model. At a 30% claim rate, if the expected payout for litigation is <$150,000, CT is the most cost-effective option, with lower costs and higher QALYs. The ICERs are high because the differences in ALYs are small. In contrast, at the expected cost of litigation in the United States ($1,000,000), the strategy with lowest event rate (SPECT) is the least costly strategy.

Conclusions:
Litigation costs for medical negligence can change the outcomes of cost-utility analyses. We consider that these should be assessed and included when an analysis is undertaken from the societal perspective.

Q-Index Code EX
Q-Index Status Provisional Code
Institutional Status UQ
Additional Notes Poster no.PCV45.

Document type: Conference Paper
Collection: School of Medicine Publications
 
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Created: Sun, 09 Jan 2011, 00:00:24 EST