Economic evaluation of the one-hour rule-out and rule-in algorithm for acute myocardial infarction using the high-sensitivity cardiac troponin T assay in the emergency department / Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitsis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller, for the TRAPID-AMI investigators

BACKGROUND: The 1-hour (h) algorithm triages patients presenting with suspected acute myocardial infarction (AMI) to the emergency department (ED) towards "rule-out," "rule-in," or "observation," depending on baseline and 1-h levels of high-sensitivity cardiac troponin (hs-cTn). The economic consequences of applying the accelerated 1-h algorithm are unknown. METHODS AND FINDINGS: We performed a post-hoc economic analysis in a large, diagnostic, multicenter study of hs-cTnT using central adjudication of the final diagnosis by two independent cardiologists. Length of stay (LoS), resource utilization (RU), and predicted diagnostic accuracy of the 1-h algorithm compared to standard of care (SoC) in the ED were estimated. The ED LoS, RU, and accuracy of the 1-h algorithm was compared to that achieved by the SoC at ED discharge. Expert opinion was sought to characterize clinical implementation of the 1-h algorithm, which required blood draws at ED presentation and 1h, after which "rule-in" patients were transferred for coronary angiography, "rule-out" patients underwent outpatient stress testing, and "observation" patients received SoC. Unit costs were for the United Kingdom, Switzerland, and Germany. The sensitivity and specificity for the 1-h algorithm were 87% and 96%, respectively, compared to 69% and 98% for SoC. The mean ED LoS for the 1-h algorithm was 4.3h-it was 6.5h for SoC, which is a reduction of 33%. The 1-h algorithm was associated with reductions in RU, driven largely by the shorter LoS in the ED for patients with a diagnosis other than AMI. The estimated total costs per patient were £2,480 for the 1-h algorithm compared to £4,561 for SoC, a reduction of up to 46%. CONCLUSIONS: The analysis shows that the use of 1-h algorithm is associated with reduction in overall AMI diagnostic costs, provided it is carefully implemented in clinical practice. These results need to be prospectively validated in the future..

Medienart:

E-Artikel

Erscheinungsjahr:

November 9, 2017

2017

Erschienen:

November 9, 2017

Enthalten in:

Zur Gesamtaufnahme - volume:12

Enthalten in:

PLOS ONE - 12(2017,11) Artikel-Nummer e0187662, 17 Seiten

Sprache:

Englisch

Beteiligte Personen:

Ambavane, Apoorva [VerfasserIn]
Giannitsis, Evangelos [VerfasserIn]
Frankenstein, Lutz, 1973- [VerfasserIn]

Links:

Volltext [kostenfrei]

Themen:

Acute Disease
Aged
Algorithms
Blood Chemical Analysis
Emergency Service, Hospital
Humans
Longevity
Myocardial Infarction
Sensitivity and Specificity
Triage
Troponin T

Anmerkungen:

Gesehen am 22.05.2018

Umfang:

17

doi:

10.1371/journal.pone.0187662

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

1575374390

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