title: Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting.
abstract: OBJECTIVE
  To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care.
  
  
  METHODS
  Prospective observational study with follow-up.
  
  
  METHODS
  Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden.
  
  
  METHODS
  All patients ≥ 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days.
  
  
  METHODS
  Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre.
  
  
  RESULTS
  A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA.
  
  
  CONCLUSIONS
  The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.
authors.affiliation: Primary Health Care and Department of Medicine and Health Sciences, Linköping University , Norrköping , Sweden.
authors.forename: Staffan
authors.initials: S
authors.lastname: Nilsson
authors.forename: Agneta
authors.initials: A
authors.lastname: Andersson
authors.forename: Magnus
authors.initials: M
authors.lastname: Janzon
authors.forename: Jan-Erik
authors.initials: JE
authors.lastname: Karlsson
authors.forename: Lars-Åke
authors.initials: LÅ
authors.lastname: Levin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers; D002637:Chest Pain / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis; D019095:Point-of-Care Systems / Q000191:economics* / Q000592:standards*; D011320:Primary Health Care / Q000191:economics*; D011446:Prospective Studies; D013548:Sweden / Q000453:epidemiology; D020107:Troponin T / Q000032:analysis* / Q000097:blood
chemical_list: D015415:Biomarkers; D020107:Troponin T
keywords: Acute myocardial infarction; Sweden; cost; general practice; point-of-care testing; primary care; troponin T