Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis
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 monit...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Published: |
Canadian Medical Association
2018
|
| Subjects: |
| _version_ | 1796961599974539264 |
|---|---|
| author | Lurati Buse, Giovanna Manns, Braden Lamy, Andre Guyatt, Gordon Polanczyk, Carisi A. Chan, Matthew T.V. Wang, Chew Yin Villar, Juan Carlos Sigamani, Alben Sessler, Daniel I. Berwanger, Otavio Biccard, Bruce M. Pearse, Rupert Urrútia, Gerard Szczeklik, R. Wojciech Garutti, Ignacio Srinathan, Sadeesh Malaga, German Abraham, Valsa Chow, Clara K. Jacka, Michael J. Tiboni, Maria Ackland, Gareth Macneil, Danielle Sapsford, Robert Leuwer, Martin Le Manach, Yannick Devereaux, Philip J. |
| author_facet | Lurati Buse, Giovanna Manns, Braden Lamy, Andre Guyatt, Gordon Polanczyk, Carisi A. Chan, Matthew T.V. Wang, Chew Yin Villar, Juan Carlos Sigamani, Alben Sessler, Daniel I. Berwanger, Otavio Biccard, Bruce M. Pearse, Rupert Urrútia, Gerard Szczeklik, R. Wojciech Garutti, Ignacio Srinathan, Sadeesh Malaga, German Abraham, Valsa Chow, Clara K. Jacka, Michael J. Tiboni, Maria Ackland, Gareth Macneil, Danielle Sapsford, Robert Leuwer, Martin Le Manach, Yannick Devereaux, Philip J. |
| author_sort | Lurati Buse, Giovanna |
| collection | UM |
| description | 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. |
| first_indexed | 2024-03-06T05:56:32Z |
| format | Article |
| id | um.eprints-22291 |
| institution | Universiti Malaya |
| last_indexed | 2024-03-06T05:56:32Z |
| publishDate | 2018 |
| publisher | Canadian Medical Association |
| record_format | dspace |
| spelling | um.eprints-222912019-09-11T04:01:41Z http://eprints.um.edu.my/22291/ Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis Lurati Buse, Giovanna Manns, Braden Lamy, Andre Guyatt, Gordon Polanczyk, Carisi A. Chan, Matthew T.V. Wang, Chew Yin Villar, Juan Carlos Sigamani, Alben Sessler, Daniel I. Berwanger, Otavio Biccard, Bruce M. Pearse, Rupert Urrútia, Gerard Szczeklik, R. Wojciech Garutti, Ignacio Srinathan, Sadeesh Malaga, German Abraham, Valsa Chow, Clara K. Jacka, Michael J. Tiboni, Maria Ackland, Gareth Macneil, Danielle Sapsford, Robert Leuwer, Martin Le Manach, Yannick Devereaux, Philip J. R Medicine 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. Canadian Medical Association 2018 Article PeerReviewed 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 https://doi.org/10.1503/cjs.010217 <https://doi.org/10.1503/cjs.010217>. https://doi.org/10.1503/cjs.010217 doi:10.1503/cjs.010217 |
| spellingShingle | R Medicine Lurati Buse, Giovanna Manns, Braden Lamy, Andre Guyatt, Gordon Polanczyk, Carisi A. Chan, Matthew T.V. Wang, Chew Yin Villar, Juan Carlos Sigamani, Alben Sessler, Daniel I. Berwanger, Otavio Biccard, Bruce M. Pearse, Rupert Urrútia, Gerard Szczeklik, R. Wojciech Garutti, Ignacio Srinathan, Sadeesh Malaga, German Abraham, Valsa Chow, Clara K. Jacka, Michael J. Tiboni, Maria Ackland, Gareth Macneil, Danielle Sapsford, Robert Leuwer, Martin Le Manach, Yannick Devereaux, Philip J. Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis |
| title | Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis |
| title_full | Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis |
| title_fullStr | Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis |
| title_full_unstemmed | Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis |
| title_short | Troponin T monitoring to detect myocardial injury after noncardiac surgery: a cost–consequence analysis |
| title_sort | troponin t monitoring to detect myocardial injury after noncardiac surgery a cost consequence analysis |
| topic | R Medicine |
| work_keys_str_mv | AT luratibusegiovanna troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT mannsbraden troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT lamyandre troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT guyattgordon troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT polanczykcarisia troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT chanmatthewtv troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT wangchewyin troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT villarjuancarlos troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT sigamanialben troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT sesslerdanieli troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT berwangerotavio troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT biccardbrucem troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT pearserupert troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT urrutiagerard troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT szczeklikrwojciech troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT garuttiignacio troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT srinathansadeesh troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT malagagerman troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT abrahamvalsa troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT chowclarak troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT jackamichaelj troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT tibonimaria troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT acklandgareth troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT macneildanielle troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT sapsfordrobert troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT leuwermartin troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT lemanachyannick troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis AT devereauxphilipj troponintmonitoringtodetectmyocardialinjuryafternoncardiacsurgeryacostconsequenceanalysis |