Key result
Routine postoperative troponin surveillance with initiation of aspirin and statin therapy in troponin-positive patients aged ≥45 years was cost-effective, with an incremental cost of –R16 724 per event avoided.
Why the study?
Is routine postoperative troponin surveillance with subsequent aspirin and statin therapy cost-effective in patients ≥45 years undergoing non-cardiac surgery?
Is routine postoperative troponin surveillance with subsequent aspirin and statin therapy cost-effective in patients ≥45 years undergoing non-cardiac surgery?
Effect estimate: -R16 724
Absolute Risk Reduction: 0.99%
Number Needed to Treat: 101
Routine postoperative troponin surveillance followed by aspirin and statin therapy in positive patients is potentially cost-effective for preventing vascular mortality and MI after non-cardiac surgery.
May support troponin surveillance after non-cardiac surgery; leaves open randomized confirmation of clinical benefit.
BACKGROUND: A postoperative troponin leak that was previously considered clinically insignificant has been independently associated with 30-day mortality in unselected surgical patients ≥45 years of age following non-cardiac surgery. OBJECTIVES: To determine whether routine troponin surveillance following non-cardiac surgery and initiation of aspirin and statin therapy in troponin-positive patients is cost-effective. METHODS: Pharmacoeconomic analysis to determine the cost-effectiveness of routine postoperative surveillance for patients aged ≥45 years undergoing non-cardiac surgery. We compared the total expected cost of hospital care of patients who received routine troponin surveillance and subsequent introduction of statin and aspirin therapy for 30 days in troponin-positive patients with the cost of hospital care of patients who did not receive troponin surveillance. We estimated a 25% relative risk reduction following statin and aspirin therapy for postoperative vascular mortality and non-fatal myocardial infarction. RESULTS: Routine troponin surveillance with initiation of aspirin and statin therapy was cost-effective, with an incremental cost of -R16,724 per event avoided. CONCLUSION: Routine postoperative troponin surveillance in non-cardiac surgical patients ≥45 years of age requiring a postoperative night in hospital is potentially cost-effective.
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Torborg et al. (2014) studied Non-cardiac surgery. Routine postoperative troponin surveillance and statin/aspirin therapy vs. No troponin surveillance was evaluated on Cost-effectiveness (incremental cost per event avoided) (-R16 724). Routine postoperative troponin surveillance with initiation of aspirin and statin therapy in troponin-positive patients aged ≥45 years was cost-effective, with an incremental cost of –R16 724 per event avoided.
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