Candidate for the Lee B. Lusted Student Prize Competition
Purpose: The aim of this study was to assess the cost effectiveness of a high-sensitive Troponin T assay (hsTnT), alone or combined with the heart-type fatty acid-binding protein (H-FABP) assay in comparison with the conventional cardiac Troponin (cTnT) assay for the diagnosis of AMI in patients presenting to the hospital with chest pain.
Method: A cost-utility analysis (Quality Adjusted Life Years-QALYs) and a cost effectiveness analysis (Life Years Gained-LYGs and AMI-deaths averted) were performed based on a decision analytic model, using a health care perspective and a life time time-horizon. One way and probabilistic sensitivity analyses were done to test the robustness of model predictions.
Result: For a life time incremental cost of 111 Euros, use of hsTnT over conventional cTnT results in gain of a QALY for 3748 Euros for AMI survivor. Use of hsTnT also saves 16-17 additional lives per 1000 AMI patients. Combination of hsTnT and H-FABP over cTnT incurs an incremental cost of 178 Euros and cost of a QALY comes to 5717 Euros. Probabilistic sensitivity analysis shows that hsTnT strategy wass dominant over combination of hsTnT with H-FABP in base case analysis and in more than 97% probabilistic draws. Cost effectiveness acceptability curves were drawn for all three diagnostic strategies to determine the probability of cost effectiveness at various cost limits that society is willing to pay to gain one QALY. The hsTnT assay was found to be cost effective in more than 90% of simulations at a ceiling ratio of 4800 Euros, being much lower than the traditionally acceptable limit of 20,000 Euros per QALY. Combination strategy remained dominated by hsTnT at all tested values of the ceiling ratio.
Incremental Cost Effectiveness Ratio(s) ICERs | ||
| Incremental cost per LYG | Incremental cost per QALY | |
| cTnT | Reference strategy | Reference strategy |
| hsTnT vs cTnT | € 2717 | € 3748 |
| hsTnT + H-FABP vs cTnT | € 4145 | € 5717 |
| hsTnT + H-FABP vs hsTnT | € 30640 | € 42262 |
Conclusion: Our analysis suggests that hsTnT assay is a very cost effective diagnostic tool relative to conventional TnT assay. Combination of hsTnT and H-FABP does not offer any additional economic and health benefit over hsTnT test alone.
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