Cost-effectiveness of the transition from Conventional to High-Sensitivity Troponin Assay for the Investigation and Management of Suspected Acute Coronary Syndrome in the Emergency Department.
Aubyn Pincombe, Jodi Gray, Siobhan Hickling, Frank Sanfilippo, Tom Briffa, Louise Cullen, Derek Chew, Graham Hillis, Daniel Fatovich, Jamie Rankink, Lee Nedkoff, Samuel Scanlan, Peter E Hickman, Stuart Stapleton, Will Parsonage, Biswadev Mitra, Hans G Schneider, Garry Wilkes, Teagan Robinson, Jon Karnonu
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引用次数: 0
Abstract
Background: Switching from conventional to high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific reference rates for threshold troponin levels enables detection of smaller amounts of myocardial damage. However, the real-world impact of these assays on patient outcomes and health service costs is poorly understood. We investigated the cost-effectiveness of switching to hs-cTn assays for patients presenting to Australian Emergency Departments (EDs) with suspected acute coronary syndrome (ACS) with a 12-month follow-up period.
Methods: Using linked administrative data from nine tertiary hospitals for patients aged 20 and above who presented to ED with suspected ACS between March 2011 and November 2015, we applied a difference-in-differences methodology to compare costs and major adverse cardiac events between hospitals switching to hs-cTn assays and hospitals continuing to use conventional assays.
Results: We identified 179,681 consecutive patients, of whom 87,019 presented during the pre-period and 92,662 the post-period. Switching to hs-cTn was associated with a reduction in the cost of the index event (-$1,022, 95% CI: -$1,034, -$1,009), a reduction in total costs at 12 months (-$1,373, 95% CI: -$1,387, -$1,360) and a reduction in the percentage of patients experiencing a MACE outcome within 12-months (-0.55%, 95% CI: -0.88%, -0.21%). The reduction in MACE outcomes was larger for female patients (-1.17%, 95% CI: -1.19%, -1.14%) than for all patients and for males.
Conclusion: The switch to hs-cTn is highly cost-effective across all patients and for each sex. The reduction in MACE outcomes and costs within 12 months are greater for females than for males.
期刊介绍:
The American Heart Journal will consider for publication suitable articles on topics pertaining to the broad discipline of cardiovascular disease. Our goal is to provide the reader primary investigation, scholarly review, and opinion concerning the practice of cardiovascular medicine. We especially encourage submission of 3 types of reports that are not frequently seen in cardiovascular journals: negative clinical studies, reports on study designs, and studies involving the organization of medical care. The Journal does not accept individual case reports or original articles involving bench laboratory or animal research.