What question did this study set out to answer?

To evaluate the real-world cost-effectiveness and impact on major adverse cardiac events of switching from conventional to high-sensitivity cardiac troponin assays for suspected acute coronary syndrome in emergency departments over a 12-month period.

April 4, 2025American Heart JournalOpen Access

Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department

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Why the study?

The real-world impact of switching to hs-cTn assays with sex-specific reference rates on patient outcomes and health service costs was poorly understood.

Does switching to high-sensitivity cardiac troponin assays reduce costs and MACE in patients presenting to the ED with suspected ACS?

Population

179,681 consecutive patients aged 20 and above presenting to 9 Australian EDs with suspected ACS

Comparison

Hospitals switching to hs-cTn assays vs hospitals continuing conventional assays

Design

Difference-in-differences analysis using linked administrative data from 9 tertiary hospitals

Follow-up

12 months

Authors

APAubyn PincombeFlinders University JGJodi GrayFlinders University SHSiobhan HicklingThe University of Western Australia

Discussion

Member takes

Implication

May not yet warrant practice change in EDs; leaves open randomized tests of hs-cTn cost-effectiveness.

Key Points

To evaluate the real-world cost-effectiveness and impact on major adverse cardiac events of switching from conventional to high-sensitivity cardiac troponin assays for suspected acute coronary syndrome in emergency departments over a 12-month period.
Linked administrative data from 9 Australian tertiary hospitals were evaluated for patients aged 20 and older presenting with suspected acute coronary syndrome between March 2011 and November 2015 (N=179,681).
A difference-in-differences methodology compared patient costs and 12-month clinical outcomes between hospitals that adopted high-sensitivity cardiac troponin assays and those continuing conventional assays.
Switching to high-sensitivity assays significantly reduced index event costs by -$1,022 (95% CI: -$1,034, -$1,009) and total 12-month healthcare costs by -$1,373 (95% CI: -$1,387, -$1,360).
Assay transition was associated with a significant reduction in 12-month major adverse cardiac events by -0.55% overall (95% CI: -0.88%, -0.21%), with a greater reduction observed among female patients (-1.17%, 95% CI: -1.19%, -1.14%).

Structured PICO

Does switching to high-sensitivity cardiac troponin assays reduce costs and MACE in patients presenting to the ED with suspected ACS?

Population

179,681 consecutive patients aged 20 and above presenting to 9 Australian Emergency Departments with suspected acute coronary syndrome (ACS) between March 2011 and November 2015

Intervention

High-sensitivity cardiac troponin (hs-cTn) assays with sex-specific reference rates

Comparator

Conventional troponin assays

Outcome

Cost of the index event, total costs at 12 months, and major adverse cardiac events (MACE) within 12 monthscomposite

Transitioning to high-sensitivity troponin assays for suspected ACS in the ED is highly cost-effective and associated with reduced 12-month MACE, particularly in women.

Cite This Study

Pincombe et al. (2025) studied this question.

synapsesocial.com/papers/6a7fca57e62c735d110fe43f https://doi.org/10.1016/j.ahj.2025.03.022

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Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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