IDEAS home Printed from https://ideas.repec.org/a/plo/pone00/0202133.html
   My bibliography  Save this article

Cost analysis of early discharge using combined copeptin/cardiac troponin testing versus serial cardiac troponin testing in patients with suspected acute coronary syndrome

Author

Listed:
  • Thomas Reinhold
  • Evangelos Giannitsis
  • Martin Möckel
  • Lutz Frankenstein
  • Mehrshad Vafaie
  • Jörn O Vollert
  • Anna Slagman

Abstract

Background: Symptoms indicating acute coronary syndrome are commonly seen in emergency rooms, but only 10% of patients are actually diagnosed with acute myocardial infarction (AMI). The Guidelines for the diagnosis of patients with suspected AMI include either multiple testing of cardiac troponin (cTN) or a single combined test of cTN and copeptin, which facilitates earlier diagnosis or exclusion of AMI. The aim of the present analysis was to investigate the impact of combined copeptin/cTN testing on health care resource consumption and related costs both during and after initial hospital treatment. Methods and results: The analysis was based on the BIC-8 trial and financial data of participating study sites. A cost analysis was carried out primarily from the hospital perspective and secondarily from the perspective of German statutory health insurers. The underlying assumptions of the investigation were tested for robustness in additional sensitivity analyses. In total, the data of 713 patients (n = 359 combined copeptin/cTN testing, n = 354 serial cTN testing) were evaluated. From a hospital perspective, the combined copeptin/cTN testing showed a reduced number of medical procedures and a lower frequency of inpatient admissions. The average staff time was significantly reduced by a mean of 49 minutes (95% confidence interval (CI) 46 to 53) per patient, accompanied by a significant mean reduction of 131 minutes (95%CI 104 to 158) in the time patients stayed in the emergency room. The initial hospital treatment was less cost-intensive. Over the entire study period, no significant cost differences were observed between the groups for health insurance. Conclusion: The combined copeptin/cTN testing has the potential to save costs and staff time in acute care and for the entire hospital stay. The primary explanations for these findings are early identification and ruling out patients without AMI along with the associated reduced need for acute medical treatment. Trial registration: ClinicalTrials.gov NCT01498731

Suggested Citation

  • Thomas Reinhold & Evangelos Giannitsis & Martin Möckel & Lutz Frankenstein & Mehrshad Vafaie & Jörn O Vollert & Anna Slagman, 2018. "Cost analysis of early discharge using combined copeptin/cardiac troponin testing versus serial cardiac troponin testing in patients with suspected acute coronary syndrome," PLOS ONE, Public Library of Science, vol. 13(8), pages 1-15, August.
    • Handle: RePEc:plo:pone00:0202133
    DOI: 10.1371/journal.pone.0202133
    as

    Download full text from publisher

    File URL: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202133
    Download Restriction: no
    File URL: https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0202133&type=printable
    Download Restriction: no
    File URL: https://libkey.io/10.1371/journal.pone.0202133?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    References listed on IDEAS

    as
    1. Andrew Briggs & Mark Sculpher & Martin Buxton, 1994. "Uncertainty in the economic evaluation of health care technologies: The role of sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 3(2), pages 95-104, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Simon Wieser & Bruno Horisberger & Sara Schmidhauser & Claudia Eisenring & Urs Brügger & Andreas Ruckstuhl & Jürg Dietrich & Anne Mannion & Achim Elfering & Özgür Tamcan & Urs Müller, 2011. "Cost of low back pain in Switzerland in 2005," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 12(5), pages 455-467, October.
    2. Martin J. Buxton & Michael F. Drummond & Ben A. Van Hout & Richard L. Prince & Trevor A. Sheldon & Thomas Szucs & Muriel Vray, 1997. "Modelling in Ecomomic Evaluation: An Unavoidable Fact of Life," Health Economics, John Wiley & Sons, Ltd., vol. 6(3), pages 217-227, May.
    3. Isaac Corro Ramos & Maureen P. M. H. Rutten-van Mölken & Maiwenn J. Al, 2013. "The Role of Value-of-Information Analysis in a Health Care Research Priority Setting," Medical Decision Making, , vol. 33(4), pages 472-489, May.
    4. Andrew Briggs & Paul Fenn, 1998. "Confidence intervals or surfaces? Uncertainty on the cost‐effectiveness plane," Health Economics, John Wiley & Sons, Ltd., vol. 7(8), pages 723-740, December.
    5. John Hutton, 2012. "‘Health Economics’ and the evolution of economic evaluation of health technologies," Health Economics, John Wiley & Sons, Ltd., vol. 21(1), pages 13-18, January.
    6. Berger, Loïc & Bleichrodt, Han & Eeckhoudt, Louis, 2013. "Treatment decisions under ambiguity," Journal of Health Economics, Elsevier, vol. 32(3), pages 559-569.
    7. Andrew H. Briggs & Milton C. Weinstein & Elisabeth A. L. Fenwick & Jonathan Karnon & Mark J. Sculpher & A. David Paltiel, 2012. "Model Parameter Estimation and Uncertainty Analysis," Medical Decision Making, , vol. 32(5), pages 722-732, September.
    8. Bangzhu Zhu & Runzhi Pang & Julien Chevallier & Yi-Ming Wei & Dinh-Tri Vo, 2019. "Including intangible costs into the cost-of-illness approach: a method refinement illustrated based on the PM2.5 economic burden in China," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(4), pages 501-511, June.
    9. Mikyung Kelly Seo & Oddbjørn Straume & Lars A. Akslen & John Cairns, 2020. "HSP27 Expression as a Novel Predictive Biomarker for Bevacizumab: is it Cost Effective?," PharmacoEconomics - Open, Springer, vol. 4(3), pages 529-539, September.
    10. Benjarin Santatiwongchai & Varit Chantarastapornchit & Thomas Wilkinson & Kittiphong Thiboonboon & Waranya Rattanavipapong & Damian G Walker & Kalipso Chalkidou & Yot Teerawattananon, 2015. "Methodological Variation in Economic Evaluations Conducted in Low- and Middle-Income Countries: Information for Reference Case Development," PLOS ONE, Public Library of Science, vol. 10(5), pages 1-15, May.
    11. Gianluca Baio & Laura Magazzini & Claudia Oglialoro & Fabio Pammolli & Massimo Riccaboni, 2005. "Medical Devices: Competitiveness and Impact on Public Health Expenditure," Working Papers CERM 05-2005, Competitività, Regole, Mercati (CERM).
    12. K Cooper & S C Brailsford & R Davies, 2007. "Choice of modelling technique for evaluating health care interventions," Journal of the Operational Research Society, Palgrave Macmillan;The OR Society, vol. 58(2), pages 168-176, February.
    13. Matthew Franklin & James Lomas & Simon Walker & Tracey Young, 2019. "An Educational Review About Using Cost Data for the Purpose of Cost-Effectiveness Analysis," PharmacoEconomics, Springer, vol. 37(5), pages 631-643, May.
    14. Kaan Sözmen & Belgin Unal & Simon Capewell & Julia Critchley & Martin O’Flaherty, 2015. "Estimating diabetes prevalence in Turkey in 2025 with and without possible interventions to reduce obesity and smoking prevalence, using a modelling approach," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 60(1), pages 13-21, January.
    15. Sebastian Gurtner, 2013. "An analysis of the influence of framework aspects on the study design of health economic modeling evaluations," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(2), pages 221-230, April.
    16. Nancy Wolff & Thomas W. Helminiak, 1996. "Nonsampling measurement error in administrative data: Implications for economic evaluations," Health Economics, John Wiley & Sons, Ltd., vol. 5(6), pages 501-512, November.
    17. Kobelt, G., 2013. "Health Economics: An Introduction to Economic Evaluation," Monographs, Office of Health Economics, number 000004.
    18. Janne Martikainen & Hannu Valtonen & Tuula Pirttilä, 2004. "Potential cost-effectiveness of a family-based program in mild Alzheimer’s disease patients," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 5(2), pages 136-142, May.
    19. Joanne Lord & Maxwell A. Asante, 1999. "Estimating uncertainty ranges for costs by the bootstrap procedure combined with probabilistic sensitivity analysis," Health Economics, John Wiley & Sons, Ltd., vol. 8(4), pages 323-333, June.
    20. Baines, Darrin & Disegna, Marta & Hartwell, Christopher A., 2021. "Portfolio frontier analysis: Applying mean-variance analysis to health technology assessment for health systems under pressure," Social Science & Medicine, Elsevier, vol. 276(C).

    More about this item

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:plo:pone00:0202133. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: plosone (email available below). General contact details of provider: https://journals.plos.org/plosone/ .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.