Abstract 6984: Cost Effectiveness of a 1-Hour High-Sensitivity Troponin-t Protocol in Suspected Acute Coronary Syndrome: A Trial-Based Analysis of the Rapid-tnt Randomised Trial

Abstract

Introduction: To better understand the economic impact of an accelerated 0/1-hour high-sensitivity troponin-T (hs-cTnT) protocol compared to conventional 0/3-hour protocol, we conducted a patient-level economic analysis of the RAPID-TnT randomised trial with a 12-month follow-up in patients presenting to emergency department (ED) with suspected acute coronary syndrome (ACS). Methods: An economic evaluation was conducted with 3265 patients randomised to either the 0/1-hour hs-cTnT protocol (n=1634) or the conventional 0/3-hour protocol (n=1631). The primary outcome measure was a composite of all-cause mortality and new/recurrent myocardial infarction (MI). Results: Mean per patients costs were numerically higher in the 0/1-hour arm compared to the conventional 0/3-hour arm (by $1830.56/patient, 95% confidence interval [95%CI]: $-1610.83 - 5271.96, P=0.30) with no statistically significant difference in primary outcome (0/1-hour: 62/1634 [3.8%], 0/3-hour: 82/1631 [5.0%], HR: 1.32 [95%CI: 095-1.83], P=0.1). The mean ED length of stay (LOS) was significantly lower in the 0/1-hour arm (by 0.63 hours/patient, 95%CI: 0.34-0.92, P<0.001), but the cost saving was offset but the higher cumulative emergency-related inpatient costs (by $2247.31/patient, 95%CI: -656.55 - 5151.18, P=0.12). Restricting the analysis to patients with hs-cTnT≤29ng/L, the mean per patients cost remained numerically higher in the 0/1-hour arm (by $1480.24/patient, 95%CI:$-1097.62 - 2058.10, P=0.26), but the reduction in ED LOS was more pronounced (by 0.75 hours/patient, 95%CI: 0.46-1.05, P<0.001). Conclusions: This economic evaluation suggest that there were no differences in costs and outcomes between the 0/1-hour hs-cTnT protocol and the conventional 0/3-hour protocol for the assessment of suspected ACS in ED after 1 year of follow-up from the Australian healthcare system perspective. Our observations suggest that the 0/1-hour hs-cTnT protocol improves initial ED efficiency with more rapid exclusion of ACS and discharge. However, the associated cost savings were offset by the subsequent emergency inpatient costs. Further refinements in cost-effective strategies to improve clinical outcomes whilst efficiently utilising healthcare resources is needed.