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  • Ambavane, ApoorvaModeling and Simulation, Evidera, London, United Kingdom (author)

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

  • Article/chapterEnglish2017

Publisher, publication year, extent ...

  • 2017-11-09
  • Public Library of Science (PLoS),2017
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-342300
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-342300URI
  • https://doi.org/10.1371/journal.pone.0187662DOI

Supplementary language notes

  • Language:English
  • Summary in:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Correction in: PLoS ONE, vol. 13, issue 1, e0191348.DOI: 10.1371/journal.pone.0191348
  • 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.

Subject headings and genre

Added entries (persons, corporate bodies, meetings, titles ...)

  • Lindahl, Bertil,1957-Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,UCR(Swepub:uu)belin227 (author)
  • Giannitsis, EvangelosMedizinische Klinik III, University Heidelberg, Heidelberg, Germany (author)
  • Roiz, JulieModeling and Simulation, Evidera, London, United Kingdom (author)
  • Mendivil, JoanMarket Access, Roche Diagnostics International Ltd., Rotkreuz, Switzerland (author)
  • Frankenstein, LutzDepartment of Cardiology, Angiology, Pulmonology, University Hospital of Heidelberg, Heidelberg, Germany (author)
  • Body, RichardEmergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom (author)
  • Christ, MichaelDepartment of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany (author)
  • Bingisser, RolandEmergency Department, University of Basel, University Hospital, Basel, Switzerland (author)
  • Alquezar, AitorServei de Urgencies. Hospital de Sant Pau, Barcelona, Spain (author)
  • Mueller, ChristianDepartment of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland (author)
  • Modeling and Simulation, Evidera, London, United KingdomUppsala kliniska forskningscentrum (UCR) (creator_code:org_t)

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  • In:PLOS ONE: Public Library of Science (PLoS)12:111932-6203

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