title: The pharmacoeconomics of routine postoperative troponin surveillance to prevent and treat myocardial infarction after non-cardiac surgery.
abstract: BACKGROUND
  A postoperative troponin leak that was previously considered clinically insignificant has been independently associated with 30-day mortality in unselected surgical patients ≥45 years of age following non-cardiac surgery.
  
  
  OBJECTIVE
  To determine whether routine troponin surveillance following non-cardiac surgery and initiation of aspirin and statin therapy in troponin-positive patients is cost-effective.
  
  
  METHODS
  Pharmacoeconomic analysis to determine the cost-effectiveness of routine postoperative surveillance for patients aged ≥45 years undergoing non-cardiac surgery. We compared the total expected cost of hospital care of patients who received routine troponin surveillance and subsequent introduction of statin and aspirin therapy for 30 days in troponin-positive patients with the cost of hospital care of patients who did not receive troponin surveillance. We estimated a 25% relative risk reduction following statin and aspirin therapy for postoperative vascular mortality and non-fatal myocardial infarction.
  
  
  RESULTS
  Routine troponin surveillance with initiation of aspirin and statin therapy was cost-effective, with an incremental cost of -R16,724 per event avoided.
  
  
  CONCLUSIONS
  Routine postoperative troponin surveillance in non-cardiac surgical patients ≥45 years of age requiring a postoperative night in hospital is potentially cost-effective.
authors.affiliation: Perioperative Research Group, Department of Anaesthetics, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa. alexandra@iafrica.com.
authors.forename: Alex
authors.initials: A
authors.lastname: Torborg
authors.forename: Lisa
authors.initials: L
authors.lastname: Ryan
authors.forename: Gary
authors.initials: G
authors.lastname: Kantor
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Biccard
mesh_terms: D001241:Aspirin / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D017721:Hospital Costs; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000191:economics / Q000627:therapeutic use*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control*; D011183:Postoperative Complications / Q000191:economics / Q000517:prevention & control*; D012306:Risk; D014336:Troponin / Q000032:analysis* / Q000191:economics
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014336:Troponin; D001241:Aspirin