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

Abstract

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. 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 0h if they had a hs-cTnI<4ng/L and at 1h if the initial value were 4ng/L and the 1-h value ≤7ng/L. Patients in the standard of care (SC) protocol used conventional cTn testing at 0 and 3h. The primary outcome was the total cost of treatment, and the secondary outcome was ED length of stay. 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, 120min) compared with the SC protocol. In lower acuity, free-standing EDs, patients under the AP experienced shorter length of stay (-37min, CI: -62, 12min) and reduced health system cost (-$112, CI: -$250, $25). Overall, the implementation of AP using hs-cTn does not result in higher costs.