Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department

作者：Aubyn Pincombe, Jodi Gray, Siobhan Hickling, Frank Sanfilippo, Tom Briffa, Louise Cullen, Derek P. Chew, Graham S. Hillis, Daniel M Fatovich, Jamie Rankink, Lee Nedkoff, Samuel L. Scanlan, Peter E. Hickman, Stuart Stapleton, William Parsonage, Biswadev Mitra, Hans G. Schneider, Garry Wilkes, Teagan Robinson, Jon Karnonu · 发表于：American Heart Journal · 年份：2025 · DOI：10.1016/j.ahj.2025.03.022 · 被引用次数：3 · 研究领域：Acute Myocardial Infarction Research、Coronary Interventions and Diagnostics、COVID-19 and healthcare impacts

BACKGROUND: Switching from conventional to high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific reference rates for threshold troponin levels enables detection of smaller amounts of myocardial damage. However, the real-world impact of these assays on patient outcomes and health service costs is poorly understood. We investigated the cost-effectiveness of switching to hs-cTn assays for patients presenting to Australian Emergency Departments (EDs) with suspected acute coronary syndrome (ACS) with a 12-month follow-up period. METHODS: Using linked administrative data from 9 tertiary hospitals for patients aged 20 and above who presented to ED with suspected ACS between March 2011 and November 2015, we applied a difference-in-differences methodology to compare costs and major adverse cardiac events between hospitals switching to hs-cTn assays and hospitals continuing to use conventional assays. RESULTS: We identified 179,681 consecutive patients, of whom 87,019 presented during the preperiod and 92,662 the postperiod. Switching to hs-cTn was associated with a reduction in the cost of the index event (-$1,022, 95% CI: -$1,034, -$1,009), a reduction in total costs at 12 months (-$1,373, 95% CI: -$1,387, -$1,360) and a reduction in the percentage of patients experiencing a MACE outcome within 12-months (-0.55%, 95% CI: -0.88%, -0.21%). The reduction in MACE outcomes was larger for female patients (-1.17%, 95% CI: -1.19%, -1.14%) than for all patients and for males. CO...