Billingsley Kaambwa1, Julie Ratcliffe2, Matthew Horsfall3, Carolyn Astley4, Jonathan Karnon5, Penelope Coates6, Margaret Arstall6, Christopher Zeitz6, Matthew Worthley6, John Beltrame6, Derek P Chew7. 1. Health Economics Unit, Flinders University, Adelaide, Australia. Electronic address: billingsley.kaambwa@flinders.edu.au. 2. Health Economics Unit, Flinders University, Adelaide, Australia. 3. Health Systems Research, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia. 4. Flinders University, Adelaide, South Australia, Australia; Heart Foundation, South Australia, Australia. 5. SA Pathology, SA Health Adelaide, South Australia, Australia. 6. University of Adelaide, South Australia, Australia. 7. Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, Australia.
Abstract
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. METHODS AND 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. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12614000189628). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365726.
RCT Entities:
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. METHODS AND 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. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ACTRN12614000189628). https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365726.
Authors: Thomas Reinhold; Evangelos Giannitsis; Martin Möckel; Lutz Frankenstein; Mehrshad Vafaie; Jörn O Vollert; Anna Slagman Journal: PLoS One Date: 2018-08-23 Impact factor: 3.240
Authors: Ming-Yu Anthony Chuang; Emmanuel S Gnanamanickam; Jonathan Karnon; Kristina Lambrakis; Matthew Horsfall; Andrew Blyth; Anil Seshadri; Mau T Nguyen; Tom Briffa; Louise A Cullen; Stephen Quinn; John K French; Derek P Chew Journal: Int J Cardiol Heart Vasc Date: 2021-12-29