title: High-sensitive troponin T assay for the diagnosis of acute myocardial infarction: an economic evaluation.
abstract: BACKGROUND
  Delayed diagnosis and treatment of Acute Myocardial Infarction (AMI) has a major adverse impact on prognosis in terms of both morbidity and mortality. Since conventional cardiac Troponin assays have a low sensitivity for diagnosing AMI in the first hours after myocardial necrosis, high-sensitive assays have been developed. The aim of this study was to assess the cost effectiveness of a high-sensitive Troponin T assay (hsTnT), alone or combined with the heart-type fatty acid-binding protein (H-FABP) assay in comparison with the conventional cardiac Troponin (cTnT) assay for the diagnosis of AMI in patients presenting to the hospital with chest pain.
  
  
  METHODS
  We performed a cost-utility analysis (quality adjusted life years-QALYs) and a cost effectiveness analysis (life years gained-LYGs) based on a decision analytic model, using a health care perspective in the Dutch context and a life time time-horizon. The robustness of model predictions was explored using one-way and probabilistic sensitivity analyses.
  
  
  RESULTS
  For a life time incremental cost of 30.70 Euros, use of hsTnT over conventional cTnT results in gain of 0.006 Life Years and 0.004 QALY. It should be noted here that hsTnT is a diagnostic intervention which costs only 4.39 Euros/test more than the cTnT test. The ICER generated with the use of hsTnT based diagnostic strategy comparing with the use of a cTnT-based strategy, is 4945 Euros per LYG and 7370 Euros per QALY. The hsTnT strategy has the highest probability of being cost effective at thresholds between 8000 and 20000 Euros per QALY. The combination of hsTnT and h-FABP strategy's probability of being cost effective remains lower than hsTnT at all willingness to pay thresholds.
  
  
  CONCLUSIONS
  Our analysis suggests that hsTnT assay is a very cost effective diagnostic tool relative to conventional TnT assay. Combination of hsTnT and H-FABP does not offer any additional economic and health benefit over hsTnT test alone.
authors.affiliation: Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre, PO Box 5800, Maastricht 6202 AZ, The Netherlands. a.vaidya@maastrichtuniversity.nl.
authors.forename: Anil
authors.initials: A
authors.lastname: Vaidya
authors.forename: Johan L
authors.initials: JL
authors.lastname: Severens
authors.forename: Brenda W C
authors.initials: BW
authors.lastname: Bongaerts
authors.forename: Kitty B J M
authors.initials: KB
authors.lastname: Cleutjens
authors.forename: Patty J
authors.initials: PJ
authors.lastname: Nelemans
authors.forename: Leonard
authors.initials: L
authors.lastname: Hofstra
authors.forename: Marja
authors.initials: M
authors.lastname: van Dieijen-Visser
authors.forename: Erik A L
authors.initials: EA
authors.lastname: Biessen
mesh_terms: D015415:Biomarkers / Q000097:blood; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D003663:Decision Trees; D042241:Early Diagnosis; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D017048:Health Care Costs; D006801:Humans; D018803:Models, Economic; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis* / Q000191:economics* / Q000628:therapy; D009426:Netherlands; D011237:Predictive Value of Tests; D011379:Prognosis; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D020107:Troponin T / Q000097:blood*
chemical_list: D015415:Biomarkers; C493408:FABP3 protein, human; D000074026:Fatty Acid Binding Protein 3; D050556:Fatty Acid-Binding Proteins; D020107:Troponin T