Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis

Lurati Buse, Giovanna and Manns, Braden and Lamy, Andre and Guyatt, Gordon and Polanczyk, Carisi A. and Chan, Matthew T.V. and Wang, Chew Yin and Villar, Juan Carlos and Sigamani, Alben and Sessler, Daniel I. and Berwanger, Otavio and Biccard, Bruce M. and Pearse, Rupert and Urrútia, Gerard and Szczeklik, R. Wojciech and Garutti, Ignacio and Srinathan, Sadeesh and Malaga, German and Abraham, Valsa and Chow, Clara K. and Jacka, Michael J. and Tiboni, Maria and Ackland, Gareth and Macneil, Danielle and Sapsford, Robert and Leuwer, Martin and Le Manach, Yannick and Devereaux, Philip J. (2018) Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis. Canadian Journal of Surgery, 61 (3). pp. 185-194. ISSN 0008-428X, DOI

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Background: Myocardial injury after noncardiac surgery (MINS) is a mostly asymptomatic condition that is strongly associated with 30-day mortality; however, it remains mostly undetected without systematic troponin T monitoring. We evaluated the cost and consequences of postoperative troponin T monitoring to detect MINS. Methods: We conducted a model-based cost-consequence analysis to compare the impact of routine troponin T monitoring versus standard care (troponin T measurement triggered by ischemic symptoms) on the incidence of MINS detection. Model inputs were based on Canadian patients enrolled in the Vascular Events in Noncardiac Surgery Patients Cohort Evaluation (VISION) study, which enrolled patients aged 45 years or older undergoing inpatient noncardiac surgery. We conducted probability analyses with 10 000 iterations and extensive sensitivity analyses. Results: The data were based on 6021 patients (48% men, mean age 65 [standard deviation 12] yr). The 30-day mortality rate for MINS was 9.6%. We determined the incremental cost to avoid missing a MINS event as $1632 (2015 Canadian dollars). The cost-effectiveness of troponin monitoring was higher in patient subgroups at higher risk for MINS, e.g., those aged 65 years or more, or with a history of atherosclerosis or diabetes ($1309). Conclusion: The costs associated with a troponin T monitoring program to detect MINS were moderate. Based on the estimated incremental cost per health gain, implementation of postoperative troponin T monitoring seems appealing, particularly in patients at high risk for MINS.

Item Type: Article
Uncontrolled Keywords: Aged; Aged, 80 and over; Cost-Benefit Analysis; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Outcome Assessment (Health Care); Postoperative Care; Postoperative Complications; Risk; Surgical Procedures, Operative; Troponin T
Subjects: R Medicine
Divisions: Faculty of Medicine
Depositing User: Ms. Juhaida Abd Rahim
Date Deposited: 11 Sep 2019 04:01
Last Modified: 11 Sep 2019 04:01

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