Cost effectiveness of high-sensitivity troponin compared to conventional troponin among patients presenting with undifferentiated chest pain: A trial based analysis.
BACKGROUND
Patients with low and intermediate risk chest pain features comprise the greatest proportion presenting to emergency services for evaluation of suspected acute coronary syndromes (ACS). The efficient and timely identification of patients with these features remains a major challenge within clinical practice. Troponin assays are increasingly being used for the determination of risk among patients presenting with chest pain potentially facilitating more appropriate care. To date, no economic evaluation comparing high-sensitivity troponin T (hs-TnT) reporting to standard troponin T (c-TnT) reporting in the routine management of suspected ACS and based on longer-term clinical outcomes has been conducted.


RESULTS
An economic evaluation was conducted with 1937 participants randomized to either hs-TnT (n=973) or c-TnT (n=964) with 12month follow-up. The primary outcome measure was the number of cumulative combined outcomes of all-cause mortality and new or recurrent ACS avoided. Mean per participant Australian Medicare costs were higher in the hs-TnT arm compared to the c-TnT arm (by $1285/patient). Mean total adverse clinical outcomes avoided were higher in the hs-TnT arm (by 0.0120/patient) resulting in an incremental cost-effectiveness ratio (ICER) of $108,552/adverse clinical outcome avoided. An ICER of $49,030/adverse clinical outcome avoided was obtained when the analysis was restricted to patients below the threshold of normal Troponin testing (actual c-TnT levels <30ng/L).


CONCLUSIONS
hs-TnT reporting leads to fewer adverse clinical events but at a high ICER. For the routine implementation of hs-TnT to be more cost-effective, substantial changes in clinical practice will be required.


BACKGROUND
Australian New Zealand Clinical Trials Registry (ACTRN12614000189628). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365726.
Health Economics Unit, Flinders University, Adelaide, Australia. Electronic address: billingsley.kaambwa@flinders.edu.au.
Billingsley
B
Kaambwa
Health Economics Unit, Flinders University, Adelaide, Australia.
Julie
J
Ratcliffe
Health Systems Research, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia.
Matthew
M
Horsfall
Flinders University, Adelaide, South Australia, Australia; Heart Foundation, South Australia, Australia.
Carolyn
C
Astley
SA Pathology, SA Health Adelaide, South Australia, Australia.
Jonathan
J
Karnon
University of Adelaide, South Australia, Australia.
Penelope
P
Coates
University of Adelaide, South Australia, Australia.
Margaret
M
Arstall
University of Adelaide, South Australia, Australia.
Christopher
C
Zeitz
University of Adelaide, South Australia, Australia.
Matthew
M
Worthley
University of Adelaide, South Australia, Australia.
John
J
Beltrame
Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia.
Derek P
DP
Chew
D000368:Aged; D001315:Australia / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002637:Chest Pain / Q000097:blood* / Q000175:diagnosis / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods; D004632:Emergency Medical Services / Q000191:economics* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000639:trends; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020107:Troponin T / Q000097:blood* / Q000191:economics*
D015415:Biomarkers; D020107:Troponin T
Acute coronary syndrome; Chest pain; Cost; Economic evaluation; High-sensitivity troponin T