title: Cost-effectiveness of presentation versus delayed troponin testing for acute myocardial infarction.
abstract: OBJECTIVE
  To estimate the cost-effectiveness of delayed troponin testing for myocardial infarction compared with troponin testing at presentation.
  
  
  METHODS
  Decision analysis modelling of cost-effectiveness using secondary data sources.
  
  
  METHODS
  Acute hospitals in the UK.
  
  
  METHODS
  Patients attending hospital with suspected myocardial infarction but a normal or non-diagnostic ECG and no major comorbidities requiring admission.
  
  
  METHODS
  Delayed troponin testing (10 h after symptom onset) compared with standard and high-sensitivity troponin testing at presentation and no testing. Sensitivity analysis evaluated high-sensitivity troponin testing 3 h after initial assessment.
  
  
  METHODS
  The incremental cost per quality-adjusted life year (QALY) gained by each strategy, compared with the next most effective alternative, and the probability of each strategy being cost-effective at varying willingness-to-pay per QALY gained.
  
  
  RESULTS
  In all scenarios tested, presentation high-sensitivity troponin testing was the most effective strategy with an incremental cost-effectiveness ratio below the £20 000/QALY threshold. 10 h troponin testing was only likely to be cost-effective if a discharge decision could be made as soon as a negative result was available and the £30 000/QALY threshold was used, or if a lower sensitivity estimate for presentation high-sensitivity troponin was assumed. Sensitivity analysis showed that including high-sensitivity troponin testing at presentation and 3 h in the analysis makes this the most cost-effective strategy.
  
  
  CONCLUSIONS
  Delayed troponin testing is unlikely to be cost-effective compared with high-sensitivity troponin testing at presentation in most scenarios. Current NICE chest pain guidelines do not promote cost-effective care.
authors.affiliation: School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK.
authors.forename: Praveen
authors.initials: P
authors.lastname: Thokala
authors.forename: Steve W
authors.initials: SW
authors.lastname: Goodacre
authors.forename: Paul O
authors.initials: PO
authors.lastname: Collinson
authors.forename: John W
authors.initials: JW
authors.lastname: Stevens
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Mills
authors.forename: David E
authors.initials: DE
authors.lastname: Newby
authors.forename: Francis
authors.initials: F
authors.lastname: Morris
authors.forename: Jason
authors.initials: J
authors.lastname: Kendall
authors.forename: Matt D
authors.initials: MD
authors.lastname: Stevenson
mesh_terms: D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D057210:Delayed Diagnosis / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000191:economics*; D019057:Quality-Adjusted Life Years; D014336:Troponin / Q000097:blood*
chemical_list: D014336:Troponin