The cost-utility of point-of-care troponin testing to diagnose acute coronary syndrome in primary care

BMC Cardiovascular Disorders

Research Article

Hendrik Koffijberg¹  Maarten J. IJzerman¹  Michelle M. A. Kip¹  Marco J. Moesker¹  Ron Kusters² 

[1] Department of Health Technology and Services Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands;Department of Health Technology and Services Research, MIRA institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands;Laboratory for Clinical Chemistry and Haematology, Jeroen Bosch Ziekenhuis, Den Bosch, the Netherlands;

关键词: Cost-utility;    Early health technology assessment;    Point-of-care testing;    Acute coronary syndrome;   

DOI  :  10.1186/s12872-017-0647-6

 received in 2017-04-06, accepted in 2017-07-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe added value of using a point-of-care (POC) troponin test in primary care to rule out acute coronary syndrome (ACS) is debated because test sensitivity is inadequate early after symptom onset. This study investigates the potential cost-utility of diagnosing ACS by a general practitioner (GP) when a POC troponin test is available versus GP assessment only.MethodsA patient-level simulation model was developed, representing a hypothetical cohort of the Dutch population (>35 years) consulting the GP with chest complaints. All health related consequences as well as cost consequences were included. Both symptom duration, selection of patients in whom the POC troponin test is performed, and test performance at different time points were incorporated. Health outcomes were expressed as Quality-Adjusted Life Years (QALYs). The main outcome parameters involve the effect of POC troponin testing on (in)correct hospital referrals, QALYs, and costs.ResultsThe POC troponin strategy decreases the referral rate in non-ACS patients from 38.46% to 31.85%. Despite a small increase in non-referral among ACS patients from 0.22% to 0.27%, the overall health effect is negligible. Costs will decrease with €77.25/patient (95% CI €-126.81 to €-33.37).ConclusionsThe POC troponin strategy is likely cost-saving, by reducing hospital referrals. The small increase in missed ACS patients can be partly explained by conservative assumptions used in the analysis. Besides, current developments in POC troponin tests will likely further improve their diagnostic performance. Therefore, future prospective studies are warranted to investigate whether those developments make the POC troponin test to a safe and cost-effective diagnostic tool for diagnosing ACS in general practices.

【 授权许可】

CC BY   
© The Author(s). 2017