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Clinical Trial
. 2014 Dec;32(4):241-7.
doi: 10.3109/02813432.2014.984901. Epub 2014 Dec 1.

Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

Staffan Nilsson  1 , Agneta Andersson, Magnus Janzon, Jan-Erik Karlsson, Lars-Åke Levin
Affiliations
Clinical Trial

Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting

Staffan Nilsson et al. Scand J Prim Health Care. 2014 Dec.

Abstract

Objective: To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care.

Design: Prospective observational study with follow-up.

Setting: Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden.

Patients: All patients ≥ 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days.

Main outcome measures: Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre.

Results: A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA.

Conclusion: The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.

Keywords: Acute myocardial infarction; Sweden; cost; general practice; point-of-care testing; primary care; troponin T.

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Figures

Figure 1.
Figure 1.
Flow chart of patients in primary health care centres (PHC centres), three with and four without point-of-care troponin T testing (POCT-TnT). Exclusion criteria: severely affected patients, other probable cause of chest pain than cardiac, for example, costal fracture or gastro-oesophageal reflux.
Figure 2.
Figure 2.
The cost-effectiveness plane (Drummond et al. 2005 [10]).
See this image and copyright information in PMC

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