Cost-effectiveness of a high-sensitivity cardiac troponin T systematic screening strategy compared with usual care to identify patients with peri-operative myocardial injury after major noncardiac surgery
Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited..
BACKGROUND: About 300 million surgeries are performed worldwide annually and this figure is increasing constantly. Peri-operative myocardial injury (PMI), detected by cardiac troponin (cTn) elevation, is a common cardiac complication of noncardiac surgery, strongly associated with short- and long-term mortality. Without systematic peri-operative cTn screening, most cases of PMI may go undetected. However, little is known about cost effectiveness of a systematic PMI screening strategy with high-sensitivity cardiac troponin T (hs-cTnT) after noncardiac surgery.
OBJECTIVE: To assess, in patients with high cardiovascular risk, the cost-effectiveness of a systematic screening strategy using a hs-cTnT assay, to identify patients with PMI after major noncardiac surgery, compared with usual care.
DESIGN: Cost-effectiveness analysis; single centre prospective cohort study.
SETTING: Spanish University Hospital.
PATIENTS: From July 2016 to March 2019, we included 1477 consecutive surgical patients aged ≥65 or if <65, with documented history of cardiovascular disease or impaired renal function, who underwent major noncardiac surgery and required at least an overnight hospital stay. We excluded patients aged <65 years without cardiovascular disease, undergoing minor surgery, or with an expected <24 h hospital stays.
INTERVENTIONS: We conducted a decision-tree analysis, comparing a systematic screening strategy measuring hs-cTnT before surgery, and at the 2nd and 3rd days after surgery vs. a usual care strategy. We considered a third-party payer perspective and the outcomes of both strategies in the short-term (30 days follow-up). Information about costs was expressed in Euros-2021. We calculated the incremental cost-effectiveness ratio (ICER) of the systematic hs-cTnT strategy, defined as the expected cost per any additional PMI detected, and explored the robustness of the model using deterministic and probabilistic sensitivity analysis.
MAIN OUTCOME MEASURES: ICER of the systematic hs-cTnT screening strategy.
RESULTS: The ICER was €425 per any additionally detected PMI. The deterministic sensitivity analysis showed that a 15% variation in costs, and a 1% variation in the predictive values, had a minor impact over the ICER, except in case of the negative predictive value of the systematic hs-cTnT screening strategy. Monte Carlo simulations (probabilistic sensitivity analysis) showed that systematic hs-cTnT screening would be cost-effective in 100% of cases with a 'willingness to pay' of €780.
CONCLUSIONS: Our results suggest that systematic peri-operative PMI screening with hs-cTnT may be cost-effective in the short-term in patients undergoing major noncardiac surgery. Economic evaluations, with a long-term horizon, are still needed.
TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03438448.
| Errataetall: |
ErratumIn: Eur J Anaesthesiol. 2023 Sep 1;40(9):717. - PMID 37530718 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:40 |
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| Enthalten in: |
European journal of anaesthesiology - 40(2023), 3 vom: 01. März, Seite 179-189 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Popova, Ekaterine [VerfasserIn] |
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| Anmerkungen: |
Date Completed 02.02.2023 Date Revised 03.12.2023 published: Print-Electronic ClinicalTrials.gov: NCT03438448 ErratumIn: Eur J Anaesthesiol. 2023 Sep 1;40(9):717. - PMID 37530718 Citation Status MEDLINE |
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| doi: |
10.1097/EJA.0000000000001793 |
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| 245 | 1 | 0 | |a Cost-effectiveness of a high-sensitivity cardiac troponin T systematic screening strategy compared with usual care to identify patients with peri-operative myocardial injury after major noncardiac surgery |
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| 500 | |a Date Revised 03.12.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT03438448 | ||
| 500 | |a ErratumIn: Eur J Anaesthesiol. 2023 Sep 1;40(9):717. - PMID 37530718 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited. | ||
| 520 | |a BACKGROUND: About 300 million surgeries are performed worldwide annually and this figure is increasing constantly. Peri-operative myocardial injury (PMI), detected by cardiac troponin (cTn) elevation, is a common cardiac complication of noncardiac surgery, strongly associated with short- and long-term mortality. Without systematic peri-operative cTn screening, most cases of PMI may go undetected. However, little is known about cost effectiveness of a systematic PMI screening strategy with high-sensitivity cardiac troponin T (hs-cTnT) after noncardiac surgery | ||
| 520 | |a OBJECTIVE: To assess, in patients with high cardiovascular risk, the cost-effectiveness of a systematic screening strategy using a hs-cTnT assay, to identify patients with PMI after major noncardiac surgery, compared with usual care | ||
| 520 | |a DESIGN: Cost-effectiveness analysis; single centre prospective cohort study | ||
| 520 | |a SETTING: Spanish University Hospital | ||
| 520 | |a PATIENTS: From July 2016 to March 2019, we included 1477 consecutive surgical patients aged ≥65 or if <65, with documented history of cardiovascular disease or impaired renal function, who underwent major noncardiac surgery and required at least an overnight hospital stay. We excluded patients aged <65 years without cardiovascular disease, undergoing minor surgery, or with an expected <24 h hospital stays | ||
| 520 | |a INTERVENTIONS: We conducted a decision-tree analysis, comparing a systematic screening strategy measuring hs-cTnT before surgery, and at the 2nd and 3rd days after surgery vs. a usual care strategy. We considered a third-party payer perspective and the outcomes of both strategies in the short-term (30 days follow-up). Information about costs was expressed in Euros-2021. We calculated the incremental cost-effectiveness ratio (ICER) of the systematic hs-cTnT strategy, defined as the expected cost per any additional PMI detected, and explored the robustness of the model using deterministic and probabilistic sensitivity analysis | ||
| 520 | |a MAIN OUTCOME MEASURES: ICER of the systematic hs-cTnT screening strategy | ||
| 520 | |a RESULTS: The ICER was €425 per any additionally detected PMI. The deterministic sensitivity analysis showed that a 15% variation in costs, and a 1% variation in the predictive values, had a minor impact over the ICER, except in case of the negative predictive value of the systematic hs-cTnT screening strategy. Monte Carlo simulations (probabilistic sensitivity analysis) showed that systematic hs-cTnT screening would be cost-effective in 100% of cases with a 'willingness to pay' of €780 | ||
| 520 | |a CONCLUSIONS: Our results suggest that systematic peri-operative PMI screening with hs-cTnT may be cost-effective in the short-term in patients undergoing major noncardiac surgery. Economic evaluations, with a long-term horizon, are still needed | ||
| 520 | |a TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT03438448 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Troponin T |2 NLM | |
| 700 | 1 | |a Alonso-Coello, Pablo |e verfasserin |4 aut | |
| 700 | 1 | |a Álvarez-García, Jesús |e verfasserin |4 aut | |
| 700 | 1 | |a Paniagua-Iglesias, Pilar |e verfasserin |4 aut | |
| 700 | 1 | |a Rué-Monné, Montserrat |e verfasserin |4 aut | |
| 700 | 1 | |a Vives-Borrás, Miguel |e verfasserin |4 aut | |
| 700 | 1 | |a Font-Gual, Adria |e verfasserin |4 aut | |
| 700 | 1 | |a Gich-Saladich, Ignasi |e verfasserin |4 aut | |
| 700 | 1 | |a Martínez-Bru, Cecilia |e verfasserin |4 aut | |
| 700 | 1 | |a Ordóñez-Llanos, Jordi |e verfasserin |4 aut | |
| 700 | 1 | |a Carles-Lavila, Misericordia |e verfasserin |4 aut | |
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