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

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Abstract

Background: The 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.

Methods: A 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.

Results: The 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).

Conclusions: The 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.

Original languageEnglish
Article number213
JournalBMC Cardiovascular Disorders
Volume17
Issue number1
DOIs
Publication statusPublished - 2 Aug 2017

Fingerprint

Point-of-Care Systems
Troponin
Acute Coronary Syndrome
Primary Health Care
Costs and Cost Analysis
General Practitioners
Referral and Consultation
Quality-Adjusted Life Years
Health
Patient Simulation
Point-of-Care Testing
General Practice
Patient Selection
Thorax
Prospective Studies

Keywords

  • Acute coronary syndrome
  • Cost-utility
  • Early health technology assessment
  • Point-of-care testing

Cite this

@article{d7a4894eccce4125af0277e1feae8457,
title = "The cost-utility of point-of-care troponin testing to diagnose acute coronary syndrome in primary care",
abstract = "Background: The 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.Methods: A 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.Results: The 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).Conclusions: The 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.",
keywords = "Acute coronary syndrome, Cost-utility, Early health technology assessment, Point-of-care testing",
author = "Kip, {Michelle M.A.} and Hendrik Koffijberg and Moesker, {Marco J.} and IJzerman, {Maarten J.} and Ron Kusters",
year = "2017",
month = "8",
day = "2",
doi = "10.1186/s12872-017-0647-6",
language = "English",
volume = "17",
journal = "BMC Cardiovascular Disorders",
issn = "1471-2261",
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number = "1",

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The cost-utility of point-of-care troponin testing to diagnose acute coronary syndrome in primary care. / Kip, Michelle M.A.; Koffijberg, Hendrik; Moesker, Marco J.; IJzerman, Maarten J.; Kusters, Ron.

In: BMC Cardiovascular Disorders, Vol. 17, No. 1, 213, 02.08.2017.

Research output: Contribution to journalArticleAcademicpeer-review

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T1 - The cost-utility of point-of-care troponin testing to diagnose acute coronary syndrome in primary care

AU - Kip, Michelle M.A.

AU - Koffijberg, Hendrik

AU - Moesker, Marco J.

AU - IJzerman, Maarten J.

AU - Kusters, Ron

PY - 2017/8/2

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N2 - Background: The 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.Methods: A 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.Results: The 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).Conclusions: The 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.

AB - Background: The 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.Methods: A 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.Results: The 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).Conclusions: The 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.

KW - Acute coronary syndrome

KW - Cost-utility

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U2 - 10.1186/s12872-017-0647-6

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JO - BMC Cardiovascular Disorders

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