High-sensitive Troponin T assay for the diagnosis of acute myocardial infarction: an economic evaluation

BMC Cardiovascular Disorders

Erik AL Biessen⁴  Marja van Dieijen-Visser³  Leonard Hofstra⁵  Patty J Nelemans²  Kitty BJM Cleutjens⁴  Brenda WC Bongaerts⁴  Johan L Severens⁶  Anil Vaidya¹ 

[1] School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands;Department of Epidemiology, Maastricht University, Maastricht, The Netherlands;Department of Clinical Chemistry, Maastricht University, Maastricht, The Netherlands;Department of Pathology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands;Cardiology Center Netherlands, Utrecht, The Netherlands;iMTA - Institute of Technology Assessment, Erasmus University Rotterdam, Rotterdam, The Netherlands

关键词: High-sensitive troponin T;    Acute myocardial infarction;    Decision model;    Cost-effectiveness;   

Others  :  854620
DOI  :  10.1186/1471-2261-14-77

 received in 2013-11-15, accepted in 2014-05-28,  发布年份 2014

【 摘 要 】

Background

Delayed diagnosis and treatment of Acute Myocardial Infarction (AMI) has a major adverse impact on prognosis in terms of both morbidity and mortality. Since conventional cardiac Troponin assays have a low sensitivity for diagnosing AMI in the first hours after myocardial necrosis, high-sensitive assays have been developed. The aim of this study was to assess the cost effectiveness of a high-sensitive Troponin T assay (hsTnT), alone or combined with the heart-type fatty acid-binding protein (H-FABP) assay in comparison with the conventional cardiac Troponin (cTnT) assay for the diagnosis of AMI in patients presenting to the hospital with chest pain.

Methods

We performed a cost-utility analysis (quality adjusted life years-QALYs) and a cost effectiveness analysis (life years gained-LYGs) based on a decision analytic model, using a health care perspective in the Dutch context and a life time time-horizon. The robustness of model predictions was explored using one-way and probabilistic sensitivity analyses.

Results

For a life time incremental cost of 30.70 Euros, use of hsTnT over conventional cTnT results in gain of 0.006 Life Years and 0.004 QALY. It should be noted here that hsTnT is a diagnostic intervention which costs only 4.39 Euros/test more than the cTnT test. The ICER generated with the use of hsTnT based diagnostic strategy comparing with the use of a cTnT-based strategy, is 4945 Euros per LYG and 7370 Euros per QALY. The hsTnT strategy has the highest probability of being cost effective at thresholds between 8000 and 20000 Euros per QALY. The combination of hsTnT and h-FABP strategy’s probability of being cost effective remains lower than hsTnT at all willingness to pay thresholds.

Conclusion

Our analysis suggests that hsTnT assay is a very cost effective diagnostic tool relative to conventional TnT assay. Combination of hsTnT and H-FABP does not offer any additional economic and health benefit over hsTnT test alone.

【 授权许可】

   
2014 Vaidya et al.; licensee BioMed Central Ltd.

【 图 表 】

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