A third troponin T blood sample is not cost-effective in patients with suspected non-ST segment elevation acute
Karam S M Alzuhairi1, Søren Hjortshøj, Søren Risom Kristensen
1Department of Cardiology, Cardiovascular Research Center, Heart Centre Aalborg, Aalborg Hospital, Aarhus University Hospital, Denmark. karam.majeed@rn.dk
Insights
A third troponin blood test for acute myocardial infarction diagnosis provides minimal clinical value and incurs significant costs. Routine use of this third sample is not cost-effective and may unnecessarily prolong hospital stays.
Area of Science:
- Cardiology
- Clinical Diagnostics
- Health Economics
Background:
- Acute myocardial infarction diagnosis relies on serial troponin levels, typically two samples 6-9 hours apart.
- A third troponin sample, 12-24 hours post-admission, is often used despite not being universally required.
- This study investigates the cost-effectiveness of routinely performing this third troponin sample.
Purpose of the Study:
- To evaluate the clinical utility and economic impact of a third troponin blood sample in diagnosing Non-ST-Elevation Acute Coronary Syndrome (NSTE-ACS).
- To determine if the additional information from a third troponin sample justifies its associated costs and potential for extended hospital stays.
Main Methods:
- A prospective study included 534 patients with suspected NSTE-ACS, collecting cardiac TroponinT (cTnT) at admission, 6-9 hours, and 12-24 hours.
- Costs associated with cTnT analysis and patient hospital stay were meticulously calculated.
- Analysis focused on identifying patients with elevated cTnT values solely in the third sample and assessing the impact on hospital length of stay.
Main Results:
- Of 124 patients with elevated cTnT, only four (3.2%) showed increased levels exclusively in the third sample.
- These four patients were clinically eligible for further investigation (coronary angiography) prior to the third sample result.
- The routine third troponin sample was associated with an extended hospital stay for 275 patients, contributing to an estimated annual cost of EUR 575,555.
Conclusions:
- The third troponin sample provides negligible additional clinical information for patient management or investigation planning in NSTE-ACS.
- Routine utilization of a third troponin sample leads to increased healthcare costs and unnecessary prolongation of hospital admission.
- Discontinuation of the routine third troponin sample could result in significant cost savings without compromising patient care.
Background:
The diagnosis of acute myocardial infarction requires troponin assessment in at least two blood samples 6-9 hours apart, with an optional third sample 12-24 hours after admission if suspicion is high. Yet, in many institutions, this third sample is routinely drawn. This study aimed to evaluate cost-effectiveness of this third sample of troponin.
Methods:
A total of 534 patients with possible Non ST-Elevation Acute Coronary Syndrome (NSTE-ACS) were included. Blood samples for cardiac TroponinT (cTnT) were obtained on arrival, after 6-9 hours, and 12-24 hours after admission. The costs of cTnT analysis, and hospital stay were calculated.
Results:
Of the 534 patients, 124 had at least one elevated cTnT value. Among these, four patients (3.2%) had cTnT values increased only in the third sample. Based on their risk profile and/or ECG changes, these four patients were eligible for referral to coronary angiography even before the result of the third sample became available. The number of patients whose length of stay was extended solely because of the third sample was 275. Incremental cost of the third blood sample: [534 patients × Euro (EUR) 12 per cTnT analysis] + [275 patients × 0.5 day × EUR 1,550] = EUR 219,533. Approximately 1400 patients with suspected NSTE-ACS are admitted to our department each year. Thus, the total cost per year is: (1,400/534) × EUR 219,533 = EUR 575,555.
Conclusion:
A third troponin sample adds no vital information regarding patients' treatment or investigations plan. On the contrary, it may lead to an unnecessary extension of the admission period and increased costs.
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