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Economic evaluation...
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
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- Ambavane, Apoorva (författare)
- Modeling and Simulation, Evidera, London, United Kingdom
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- Lindahl, Bertil, 1957- (författare)
- Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,UCR
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- Giannitsis, Evangelos (författare)
- Medizinische Klinik III, University Heidelberg, Heidelberg, Germany
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- Roiz, Julie (författare)
- Modeling and Simulation, Evidera, London, United Kingdom
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- Mendivil, Joan (författare)
- Market Access, Roche Diagnostics International Ltd., Rotkreuz, Switzerland
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- Frankenstein, Lutz (författare)
- Department of Cardiology, Angiology, Pulmonology, University Hospital of Heidelberg, Heidelberg, Germany
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- Body, Richard (författare)
- Emergency Department, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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- Christ, Michael (författare)
- Department of Emergency and Critical Care Medicine, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
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- Bingisser, Roland (författare)
- Emergency Department, University of Basel, University Hospital, Basel, Switzerland
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- Alquezar, Aitor (författare)
- Servei de Urgencies. Hospital de Sant Pau, Barcelona, Spain
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- Mueller, Christian (författare)
- Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland
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(creator_code:org_t)
- 2017-11-09
- 2017
- Engelska.
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 12:11
- Relaterad länk:
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https://doi.org/10.1...
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https://uu.diva-port... (primary) (Raw object)
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https://journals.plo...
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https://urn.kb.se/re...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- 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.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
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Ambavane, Apoorv ...
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Lindahl, Bertil, ...
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Giannitsis, Evan ...
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Roiz, Julie
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Mendivil, Joan
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Frankenstein, Lu ...
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Body, Richard
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Christ, Michael
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Bingisser, Rolan ...
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Alquezar, Aitor
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Mueller, Christi ...
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