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

Shooshan Danagoulian; Joseph Miller; Bernard Cook; Satheesh Gunaga; Raef Fadel; Chaun Gandolfo; Nicholas L Mills; Shalini Modi; Simon Mahler; Phillip Levy; Sachin Parikh; Seth Krupp; Khaled Abdul-Nour; Howard Klausner; Steven Rockoff; Ryan Gindi; Aaron Lewandowski; Michael Hudson; Guiseppe Perrotta; Brian Zweig; David Lanfear; Henry Kim; Elizabeth Shaheen; Gale Darnell; Hashem Nassereddine; Kegham Hawatian; Amy Tang; Catriona Keerie; James McCord

doi:10.1002/emp2.13140

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

Shooshan Danagoulian^*, Joseph Miller, Bernard Cook, Satheesh Gunaga, Raef Fadel, Chaun Gandolfo, Nicholas L Mills, Shalini Modi, Simon Mahler, Phillip Levy, Sachin Parikh, Seth Krupp, Khaled Abdul-Nour, Howard Klausner, Steven Rockoff, Ryan Gindi, Aaron Lewandowski, Michael Hudson, Guiseppe Perrotta, Brian ZweigDavid Lanfear, Henry Kim, Elizabeth Shaheen, Gale Darnell, Hashem Nassereddine, Kegham Hawatian, Amy Tang, Catriona Keerie, James McCord

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract / Description of output

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.

Original language	English
Article number	e13140
Number of pages	8
Journal	Journal of the American College of Emergency Physicians Open
Volume	5
Issue number	2
DOIs	https://doi.org/10.1002/emp2.13140
Publication status	Published - 2 Apr 2024

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Danagoulian, S., Miller, J., Cook, B., Gunaga, S., Fadel, R., Gandolfo, C., Mills, N. L., Modi, S., Mahler, S., Levy, P., Parikh, S., Krupp, S., Abdul-Nour, K., Klausner, H., Rockoff, S., Gindi, R., Lewandowski, A., Hudson, M., Perrotta, G., ... McCord, J. (2024). Is rapid acute coronary syndrome evaluation with high-sensitivity cardiac troponin less costly? An economic evaluation. Journal of the American College of Emergency Physicians Open, 5(2), Article e13140. https://doi.org/10.1002/emp2.13140

@article{7d69c7b05b1246be926a101e0ce38345,

title = "Is rapid acute coronary syndrome evaluation with high-sensitivity cardiac troponin less costly? An economic evaluation",

abstract = "ObjectiveProtocols 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.MethodsWe 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.ResultsAmong 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).ConclusionOverall, the implementation of AP using hs-cTn does not result in higher costs.",

author = "Shooshan Danagoulian and Joseph Miller and Bernard Cook and Satheesh Gunaga and Raef Fadel and Chaun Gandolfo and Mills, {Nicholas L} and Shalini Modi and Simon Mahler and Phillip Levy and Sachin Parikh and Seth Krupp and Khaled Abdul-Nour and Howard Klausner and Steven Rockoff and Ryan Gindi and Aaron Lewandowski and Michael Hudson and Guiseppe Perrotta and Brian Zweig and David Lanfear and Henry Kim and Elizabeth Shaheen and Gale Darnell and Hashem Nassereddine and Kegham Hawatian and Amy Tang and Catriona Keerie and James McCord",

year = "2024",

month = apr,

day = "2",

doi = "10.1002/emp2.13140",

language = "English",

volume = "5",

journal = "Journal of the American College of Emergency Physicians Open",

issn = "2688-1152",

publisher = "Wiley Open Access",

number = "2",

}

Danagoulian, S, Miller, J, Cook, B, Gunaga, S, Fadel, R, Gandolfo, C, Mills, NL, Modi, S, Mahler, S, Levy, P, Parikh, S, Krupp, S, Abdul-Nour, K, Klausner, H, Rockoff, S, Gindi, R, Lewandowski, A, Hudson, M, Perrotta, G, Zweig, B, Lanfear, D, Kim, H, Shaheen, E, Darnell, G, Nassereddine, H, Hawatian, K, Tang, A, Keerie, C & McCord, J 2024, 'Is rapid acute coronary syndrome evaluation with high-sensitivity cardiac troponin less costly? An economic evaluation', Journal of the American College of Emergency Physicians Open, vol. 5, no. 2, e13140. https://doi.org/10.1002/emp2.13140

TY - JOUR

T1 - Is rapid acute coronary syndrome evaluation with high-sensitivity cardiac troponin less costly? An economic evaluation

AU - Danagoulian, Shooshan

AU - Miller, Joseph

AU - Cook, Bernard

AU - Gunaga, Satheesh

AU - Fadel, Raef

AU - Gandolfo, Chaun

AU - Mills, Nicholas L

AU - Modi, Shalini

AU - Mahler, Simon

AU - Levy, Phillip

AU - Parikh, Sachin

AU - Krupp, Seth

AU - Abdul-Nour, Khaled

AU - Klausner, Howard

AU - Rockoff, Steven

AU - Gindi, Ryan

AU - Lewandowski, Aaron

AU - Hudson, Michael

AU - Perrotta, Guiseppe

AU - Zweig, Brian

AU - Lanfear, David

AU - Kim, Henry

AU - Shaheen, Elizabeth

AU - Darnell, Gale

AU - Nassereddine, Hashem

AU - Hawatian, Kegham

AU - Tang, Amy

AU - Keerie, Catriona

AU - McCord, James

PY - 2024/4/2

Y1 - 2024/4/2

N2 - ObjectiveProtocols 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.MethodsWe 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.ResultsAmong 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).ConclusionOverall, the implementation of AP using hs-cTn does not result in higher costs.

AB - ObjectiveProtocols 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.MethodsWe 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.ResultsAmong 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).ConclusionOverall, the implementation of AP using hs-cTn does not result in higher costs.

U2 - 10.1002/emp2.13140

DO - 10.1002/emp2.13140

M3 - Article

SN - 2688-1152

VL - 5

JO - Journal of the American College of Emergency Physicians Open

JF - Journal of the American College of Emergency Physicians Open

IS - 2

M1 - e13140

ER -

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

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