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
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...
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| Hauptverfasser: | , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
November 9, 2017
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| In: |
PLOS ONE
Year: 2017, Jahrgang: 12, Heft: 11 |
| ISSN: | 1932-6203 |
| DOI: | 10.1371/journal.pone.0187662 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: http://dx.doi.org/10.1371/journal.pone.0187662
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| Verfasserangaben: | Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitsis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller, for the TRAPID-AMI investigators |
MARC
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| 245 | 1 | 0 | |a 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 |c Apoorva Ambavane, Bertil Lindahl, Evangelos Giannitsis, Julie Roiz, Joan Mendivil, Lutz Frankenstein, Richard Body, Michael Christ, Roland Bingisser, Aitor Alquezar, Christian Mueller, for the TRAPID-AMI investigators |
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| 520 | |a 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. | ||
| 650 | 4 | |a Acute Disease | |
| 650 | 4 | |a Aged | |
| 650 | 4 | |a Algorithms | |
| 650 | 4 | |a Blood Chemical Analysis | |
| 650 | 4 | |a Emergency Service, Hospital | |
| 650 | 4 | |a Humans | |
| 650 | 4 | |a Longevity | |
| 650 | 4 | |a Myocardial Infarction | |
| 650 | 4 | |a Sensitivity and Specificity | |
| 650 | 4 | |a Triage | |
| 650 | 4 | |a Troponin T | |
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| 700 | 1 | |a Frankenstein, Lutz |d 1973- |e VerfasserIn |0 (DE-588)124198937 |0 (DE-627)63440766X |0 (DE-576)328373281 |4 aut | |
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