Is rapid acute coronary syndrome evaluation with high-sensitivity cardiac troponin less costly? An economic evaluation.

Objective: Protocols to evaluate for myocardial infarction (MI) using high-sensitivity cardiac troponin (hs-cTn) have the potential to drive costs upward due to the added sensitivity. We performed an economic evaluation of an accelerated protocol (AP) to evaluate for MI using hs-cTn to identify changes in costs of treatment and length of stay compared with conventional testing.
Methods: We performed a planned secondary economic analysis of a large, cluster randomized trial across nine emergency departments (EDs) from July 2020 to April 2021. Patients were included if they were 18 years or older with clinical suspicion for MI. In the AP, patients could be discharged without further testing at 0 h if they had a hs-cTnI < 4 ng/L and at 1 h if the initial value were 4 ng/L and the 1-h value ≤7 ng/L. Patients in the standard of care (SC) protocol used conventional cTn testing at 0 and 3 h. The primary outcome was the total cost of treatment, and the secondary outcome was ED length of stay.
Results: Among 32,450 included patients, an AP had no significant differences in cost (+$89, CI: -$714, $893 hospital cost, +$362, CI: -$414, $1138 health system cost) or ED length of stay (+46, CI: -28, 120 min) compared with the SC protocol. In lower acuity, free-standing EDs, patients under the AP experienced shorter length of stay (-37 min, CI: -62, 12 min) and reduced health system cost (-$112, CI: -$250, $25).
Conclusion: Overall, the implementation of AP using hs-cTn does not result in higher costs.
Competing Interests: Joe Miller: Research support and consulting for Beckman Coulter; consulting for Siemens and AstraZeneca. Ben Cook: Research support for Abbott; research support and consulting for Beckman Coulter; research support for Roche. David Lanfear: Abbott Laboratories, Amgen, Astra Zeneca, Cytokinetics, DCRI (CONNECT‐HF), Illumina, Janssen, Lilly, Martin Pharmaceuticals, Ortho Diagnostics, Otsuka, Somalogic, Vicardia. Simon Mahler: funding/support from Roche Diagnostics, Abbott Laboratories, Ortho Clinical Diagnostics, Siemens, Grifols, Pathfast, Quidel, and HRSA (1H2ARH399760100). He is an advisor for Roche Diagnostics, Abbott Laboratories, Genetesis, Quidel, Inflammatix, Radiometer, and Amgen and the Chief Medical Officer for Impathiq Inc. Phil Levy: past chair of the American College of Cardiology (ACC) Accreditation Oversight Committee and a current member of the ACC NCDR Oversight Committee and the NCDR Chest Pain/MI Registry Publications Committee; he was also Vice Chair for the ACC/AHA Chest Pain Guidelines. Dr. Levy has served as a consultant for Quidel, Siemens, Roche Diagnostics, Ortho Diagnostics, Beckman Coulter, Pathfast, and the Baim Institute. James McCord: research support for Roche and Abbott; research support and consulting for Siemens and Beckman Coulter. Nicholas Mills has received honoraria or consultancy from Abbott Diagnostics, Roche Diagnostics, Siemens Healthineers, and LumiraDx, and the University of Edinburgh has received research grants from Abbott Diagnostics and Siemens Healthineers is supported by Chair, Programme and Research Excellence Awards (CH/F/21/90010, RG/20/10/34966, RE/18/5/34216) from the British Heart Foundation. Other coauthors have no disclosures to make.
(© 2024 The Authors. Journal of the American College of Emergency Physicians Open published by Wiley Periodicals LLC on behalf of American College of Emergency Physicians.)