Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department

Pincombe, A; Gray, J; Hickling, S; Sanfilippo, F; Briffa, T; Cullen, L; Chew, D; Hillis, G; Fatovich, D; Rankin, J; Nedkoff, L; Scanlan, S; Hickman, PE; Stapleton, S; Parsonage, W; Mitra, B; Schneider, HG; Wilkes, G; Robinson, T; Karnon, J

doi:10.1016/j.ahj.2025.03.022

Coronary disease & ACS

Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department

Am Heart JPublished 2 Apr 2025difference-in-differences

Main finding · Cost of the index eventResultDifference -$1,022 95% CI -$1,034, -$1,009

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Authors' conclusion

The switch to hs-cTn is highly cost-effective across all patients and for each sex. The reduction in MACE outcomes and costs within 12 months are greater for females than for males.

Study context

Population: Patients aged 20 and above presenting to Australian Emergency Departments (EDs) with suspected acute coronary syndrome (ACS) between March 2011 and November 2015preperiod 87,019 · postperiod 92,662
Participants: 179,681 consecutive patients

Comparison: Hospitals switching to high-sensitivity cardiac troponin (hs-cTn) assays and hospitals continuing to use conventional assays
Outcome: Cost of the index event

Methodological detailslinked administrative data, 9 tertiary hospitals, 12-month follow-up period

Linked administrative data
9 tertiary hospitals
12-month follow-up period

Main finding

As reported in the abstract

Difference

-$1,022

95% CI -$1,034, -$1,009

Further findings

Outcome	← Lower with hospitals switching to hs-cTn assays ←→ Higher with hospitals switching to hs-cTn assays →	Difference (95% CI)
Percentage of patients experiencing a MACE outcome · within 12-monthsReduction with switching to hs-cTn	−1.5−1−0.500.5	−0.55% (−0.88% to −0.21%)
MACE outcomes, female patients (subgroup)	−1.5−1−0.500.5	−1.17% (−1.19% to −1.14%)
	−1.5−1−0.500.5Difference (linear scale)

Outcome	Difference (95% CI)
Total costs · 12 monthsReduction with switching to hs-cTn	-$1,373 (-$1,387, -$1,360)

MACE outcomes, female patients (subgroup): female patients; larger reduction than for all patients and for males

Original publication

Cost-effectiveness of the transition from conventional to high-sensitivity troponin assay for the investigation and management of suspected acute coronary syndrome in the emergency department. Am Heart J. Published 2 April 2025. doi:10.1016/j.ahj.2025.03.022

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Summarised from the published abstract; every number is checked against it