PMD4 - Cost-Effectiveness Analysis of High-Sensitivity Troponin T Versus Conventional Troponin I Testing for Acute Myocardial Infarction

Abstract

High-sensitivity cardiac troponin T (hs-TnT) assays have improved early diagnostic accuracy of myocardial infarction (MI). The safety of hs-TnT based 0-hour/1-hour algorithm for early exclusion of MI in suspected patients has been validated in several studies. However, the cost-effectiveness of the 0-hour/1-hour algorithm as compared to the conventional diagnosis pathway has not been fully analyzed, especially in the healthcare settings of the Asian countries. We conducted a cost-effectiveness analysis from a third-party payer perspective using Asian data. We designed a clinical decision model to evaluate the cost-effectiveness (CE) of the 0-hour/1-hour algorithm. Effectiveness or efficacy data were abstracted from the a Japan-Taiwanese validation study, healthcare process and human resources data were extracted from the electronic medical record database of a tertiary hospital in Taiwan, and cost data were derived from the National Health Insurance Research Database of Taiwan from 2011 to 2013. The clinical outcomes were measured by quality-adjusted life year (QALY). Monte Carlo simulation was used to derive incremental cost-effectiveness ratio (ICER) estimates with confidence intervals. We plotted the pairs of incremental costs and QALYs on the CE plane. Compared to conventional diagnostic pathway, the 0-hour/1-hour accelerated diagnosis algorithm resulted in fewer overnight emergency department stays (60.3% vs. 24.1%), fewer cardiology referrals (32.4% vs. 20.9%), and lower healthcare human resources ($11,236.80 vs. $8,528.20 USD). Use of hs-cTnT was associated with an ICER of [$14,082.40] per QALY gained. The majority of incremental cost-QALY pairs fall in the dominant quadrant of the CE plane, indicating that using hs-cTnT is cost-saving with better outcomes. The 0-hour/1-hour algorithm based on hs-TnT assays is cost effective in the Taiwanese healthcare setting.