Impact of point-of-care high-sensitivity troponin testing on index admission and 30-day costs: secondary analysis of a randomised controlled trial
I V L Thulin, S M F Jordalen, J J Gangstoe, J Krishnapillai, O C Lekven, R Body, P Collinson, F Apple, L Cullen, T M Norekval, T Wisloff, K Vikenes, R O Bjorneklett, T Omland, K M AakreAbstract
Background
Point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) assays provide rapid turnaround times and are increasingly considered for use within guideline recommended 0/1-hour accelerated diagnostic protocols (ADPs). However, higher per-test costs raise concerns regarding overall economic impact. Randomised evaluations of real-world implementation remain limited.
Purpose
To assess the effect of implementing POC hs-cTnI testing within a 0/1-hour ADP on total index admission costs and 30-day specialist care costs.
Methods
This pre-specified secondary analysis of a single-centre randomised controlled trial included 1,494 adults presenting with suspected acute coronary syndrome. Participants were randomised 1:1 to 0/1-hour POC hs-cTnI testing or central laboratory hs-cTnT testing. Costs were estimated from the healthcare provider perspective using Norwegian patient-level costing and Diagnosis-Related Group frameworks. Resource use was extracted from electronic hospital records. Unadjusted mean cost differences were estimated using non-parametric bootstrap resampling. To account for potential confounders, a generalised linear model with gamma distribution and log link was fitted, adjusting for age, sex, adjudicated diagnosis, and disposition.
Results
Mean total index admission cost was €3,083 in the POC group and €3,126 in the control group (mean difference −€43; 95%CI −510 to 423). In adjusted analyses, costs remained similar between groups (adjusted mean difference €11; 95%CI −183 to 204). Mean total specialist care costs from admission to 30 days were €3,517 in the POC group and €3,413 in the control group (mean difference €105; 95%CI −405 to 615). Cost patterns were consistent across diagnostic and disposition subgroups.
Conclusion
In this randomised evaluation, implementation of POC hs-cTnI testing within a 0/1-hour ADP was cost-neutral at both index admission and 30 days. Despite higher per-test costs, overall episode costs were not increased. These findings suggest that biomarker pricing alone is unlikely to be a major driver of total healthcare expenditure when POC hs-cTn testing is integrated into emergency department pathways.Mean total index admission costs