Cost-effectiveness of a high-sensitivity cardiac troponin T systematic screening strategy compared with usual care to identify patients with peri-operative myocardial injury after major noncardiac surgery
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Media type:
E-Article
Title:
Cost-effectiveness of a high-sensitivity cardiac troponin T systematic screening strategy compared with usual care to identify patients with peri-operative myocardial injury after major noncardiac surgery
Description:
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<jats:title>BACKGROUND</jats:title>
<jats:p>About 300 million surgeries are performed worldwide annually and this figure is increasing constantly. Peri-operative myocardial injury (PMI), detected by cardiac troponin (cTn) elevation, is a common cardiac complication of noncardiac surgery, strongly associated with short- and long-term mortality. Without systematic peri-operative cTn screening, most cases of PMI may go undetected. However, little is known about cost effectiveness of a systematic PMI screening strategy with high-sensitivity cardiac troponin T (hs-cTnT) after noncardiac surgery.</jats:p>
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<jats:title>OBJECTIVE</jats:title>
<jats:p>To assess, in patients with high cardiovascular risk, the cost-effectiveness of a systematic screening strategy using a hs-cTnT assay, to identify patients with PMI after major noncardiac surgery, compared with usual care.</jats:p>
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<jats:title>DESIGN</jats:title>
<jats:p>Cost-effectiveness analysis; single centre prospective cohort study.</jats:p>
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<jats:title>SETTING</jats:title>
<jats:p>Spanish University Hospital.</jats:p>
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<jats:title>PATIENTS</jats:title>
<jats:p>From July 2016 to March 2019, we included 1477 consecutive surgical patients aged ≥65 or if <65, with documented history of cardiovascular disease or impaired renal function, who underwent major noncardiac surgery and required at least an overnight hospital stay. We excluded patients aged <65 years without cardiovascular disease, undergoing minor surgery, or with an expected <24 h hospital stays.</jats:p>
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<jats:title>INTERVENTIONS</jats:title>
<jats:p>We conducted a decision-tree analysis, comparing a systematic screening strategy measuring hs-cTnT before surgery, and at the 2nd and 3rd days after surgery vs. a usual care strategy. We considered a third-party payer perspective and the outcomes of both strategies in the short-term (30 days follow-up). Information about costs was expressed in Euros-2021. We calculated the incremental cost-effectiveness ratio (ICER) of the systematic hs-cTnT strategy, defined as the expected cost per any additional PMI detected, and explored the robustness of the model using deterministic and probabilistic sensitivity analysis.</jats:p>
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<jats:title>MAIN OUTCOME MEASURES</jats:title>
<jats:p>ICER of the systematic hs-cTnT screening strategy.</jats:p>
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<jats:title>RESULTS</jats:title>
<jats:p>The ICER was €425 per any additionally detected PMI. The deterministic sensitivity analysis showed that a 15% variation in costs, and a 1% variation in the predictive values, had a minor impact over the ICER, except in case of the negative predictive value of the systematic hs-cTnT screening strategy. Monte Carlo simulations (probabilistic sensitivity analysis) showed that systematic hs-cTnT screening would be cost-effective in 100% of cases with a ‘willingness to pay’ of €780.</jats:p>
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<jats:title>CONCLUSIONS</jats:title>
<jats:p>Our results suggest that systematic peri-operative PMI screening with hs-cTnT may be cost-effective in the short-term in patients undergoing major noncardiac surgery. Economic evaluations, with a long-term horizon, are still needed.</jats:p>
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<jats:title>TRIAL REGISTRATION</jats:title>
<jats:p>Clinicaltrials.gov identifier: NCT03438448.</jats:p>
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