ECONOMIC AND PROGNOSTIC VALUE OF HIGH-SENSITIVITY CARDIAC TROPONIN I IN EMERGENCY DEPARTMENT CHEST PAIN TRIAGE
Author(s)
Artem T. Boltyenkov, MBA, PhD1, Wanyi Chen, PhD2, Allan S. Jaffe, MD3, Fred S. Apple, PhD4, Christopher R. deFilippi, MD5, W. Frank Peacock, MD6, Alan H. Wu, Ph.D.7, Rana Fayyad, Ph.D.8, Sarah A. Bethoney, Ph.D.8, Jingjing Zhang, MS8;
1Siemens Healthcare Diagnostics Inc., Head, Global HEOR, Lexington, SC, USA, 2Siemens Healthcare Diagnostics Inc., Walpole, MA, USA, 3Mayo Clinic, Rochester, MN, USA, 4Hennepin Healthcare, Minneapolis, MN, USA, 5University of Maryland School of Medicine, Baltimore, MD, USA, 6Baylor College of Medicine, Houston, TX, USA, 7UCSF, San Francisco, CA, USA, 8Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA
1Siemens Healthcare Diagnostics Inc., Head, Global HEOR, Lexington, SC, USA, 2Siemens Healthcare Diagnostics Inc., Walpole, MA, USA, 3Mayo Clinic, Rochester, MN, USA, 4Hennepin Healthcare, Minneapolis, MN, USA, 5University of Maryland School of Medicine, Baltimore, MD, USA, 6Baylor College of Medicine, Houston, TX, USA, 7UCSF, San Francisco, CA, USA, 8Siemens Healthcare Diagnostics Inc., Tarrytown, NY, USA
OBJECTIVES: Among emergency department (ED) patients with suspected acute coronary syndrome (ACS) but without myocardial infarction (MI), efficient risk stratification remains challenging. High-sensitivity cardiac troponin I (hs-cTnI) is an established prognostic biomarker, yet its incremental economic value alongside clinical risk scores for guiding hospital admission decisions is uncertain. This study quantified the cost and clinical impact of requiring elevated hs-cTnI as a conjunctive admission criterion with established risk scores versus using risk scores alone.
METHODS: We conducted a secondary analysis of 1,853 non-MI chest pain patients from the prospective HIGH-US study across 29 U.S. EDs (2014-2016). We modeled six hospital admission pathways: three using risk scores alone (HEAR≥4, sEDACS≥15, TIMI≥1) and three requiring both elevated baseline hs-cTnI (≥99th percentile) and high-risk scores. Outcomes included admission rates, 30-day death/MI prediction accuracy (sensitivity, specificity, negative predictive value), and per-patient diagnostic costs based on Medicare reimbursement rates. Costs encompassed ED visits, laboratory testing, cardiac imaging, and cardiology services over a 30-day horizon from a U.S. healthcare provider perspective.
RESULTS: Risk-score-only pathways would have hospitalized 52-87% of patients at $796-$988 per patient, with specificity ≤48% for 30-day death/MI. Adding hs-cTnI as a conjunctive requirement significantly reduced hospitalizations to ≤9% (p<0.05), lowered costs to ≤$548 per patient (31-45% reduction, p<0.05), and improved specificity to ≥91% (p<0.05). Negative predictive values remained high (≥99.2%), though sensitivity decreased (≤23.5%, p<0.05). Benefits were most pronounced among intermediate-risk patients, where hs-cTnI reduced admissions by up to 89% and costs by up to 39%.
CONCLUSIONS: Integrating hs-cTnI into ED admission pathways substantially reduces hospitalizations and diagnostic expenditures while improving risk stratification accuracy. These findings demonstrate the economic value of leveraging hs-cTnI's prognostic information to optimize resource utilization in chest pain management.
METHODS: We conducted a secondary analysis of 1,853 non-MI chest pain patients from the prospective HIGH-US study across 29 U.S. EDs (2014-2016). We modeled six hospital admission pathways: three using risk scores alone (HEAR≥4, sEDACS≥15, TIMI≥1) and three requiring both elevated baseline hs-cTnI (≥99th percentile) and high-risk scores. Outcomes included admission rates, 30-day death/MI prediction accuracy (sensitivity, specificity, negative predictive value), and per-patient diagnostic costs based on Medicare reimbursement rates. Costs encompassed ED visits, laboratory testing, cardiac imaging, and cardiology services over a 30-day horizon from a U.S. healthcare provider perspective.
RESULTS: Risk-score-only pathways would have hospitalized 52-87% of patients at $796-$988 per patient, with specificity ≤48% for 30-day death/MI. Adding hs-cTnI as a conjunctive requirement significantly reduced hospitalizations to ≤9% (p<0.05), lowered costs to ≤$548 per patient (31-45% reduction, p<0.05), and improved specificity to ≥91% (p<0.05). Negative predictive values remained high (≥99.2%), though sensitivity decreased (≤23.5%, p<0.05). Benefits were most pronounced among intermediate-risk patients, where hs-cTnI reduced admissions by up to 89% and costs by up to 39%.
CONCLUSIONS: Integrating hs-cTnI into ED admission pathways substantially reduces hospitalizations and diagnostic expenditures while improving risk stratification accuracy. These findings demonstrate the economic value of leveraging hs-cTnI's prognostic information to optimize resource utilization in chest pain management.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE104
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)