Format

Send to

Choose Destination
See comment in PubMed Commons below
Ann Intern Med. 1999 Dec 21;131(12):909-18.

Emergency department triage strategies for acute chest pain using creatine kinase-MB and troponin I assays: a cost-effectiveness analysis.

Author information

1
Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health, Boston, Massachusetts, USA.

Abstract

BACKGROUND:

Evaluation of acute chest pain is highly variable.

OBJECTIVE:

To evaluate the cost-effectiveness of strategies using cardiac markers and noninvasive tests for myocardial ischemia.

DESIGN:

Cost-effectiveness analysis.

DATA SOURCES:

Prospective data from 1066 patients with chest pain and from the published literature.

TARGET POPULATION:

Patients admitted with acute chest pain.

TIME HORIZON:

Lifetime.

PERSPECTIVE:

Societal.

INTERVENTIONS:

Creatine kinase (CK)-MB mass assay alone; CK-MB mass assay followed by cardiac troponin I assay if the CK-MB value is normal; CK-MB mass assay followed by troponin I assay if the CK-MB value is normal and electrocardiography shows ischemic changes; both CK-MB mass and troponin I assays; and troponin I assay alone. These strategies were evaluated alone or in combination with early exercise testing.

OUTCOME MEASURES:

Lifetime cost, life expectancy (in years), and incremental cost-effectiveness.

RESULTS OF BASE-CASE ANALYSIS:

For patients 55 to 64 years of age, measurement of CK-MB mass followed by exercise testing in appropriate patients was the most competitive strategy ($43000 per year of life saved). Measurement of CK-MB mass followed by troponin I measurement had an incremental cost-effectiveness ratio of $47400 per year of life saved for patients 65 to 74 years of age; it was also the most cost-effective strategy when early exercise testing could not be performed, CK-MB values were normal, and ischemic changes were seen on electrocardiography.

RESULTS OF SENSITIVITY ANALYSIS:

Results were influenced by age, probability of myocardial infarction, and medical costs.

CONCLUSIONS:

Measurement of CK-MB mass plus early exercise testing is a cost-effective initial strategy for younger patients and those with a low to moderate probability of myocardial infarction. Troponin I measurement can be a cost-effective second test in higher-risk subsets of patients if the CK-MB level is normal and early exercise testing is not an option.

PMID:
10610641
[Indexed for MEDLINE]
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Silverchair Information Systems
    Loading ...
    Support Center