OBJECTIVES : Early economic evaluation was performed to compare the indicative cost savings from the use of a high sensitivity cardiac troponin (hs-cTn) biomarker as Point of Care (POC) testing versus hs-cTn central laboratory testing. This laboratory test is designated a Rapid Uptake (RAU) Product by the NHS Accelerated Access Collaborative (AAC). Its use is recommended by NICE Diagnostic Guideline DG115 for patients presenting with chest pain at emergency department (ED).

METHODS : The study models the impact of hs-cTn POC testing patients arriving with chest pain at ED for suspected acute myocardial infarction (AMI). Three ED routes modelled were testing at ‘0’, ‘1’ and ‘3’ hours. Decision-analytic models were developed and in Excel comparing POC testing to standard care in the ED. Outcomes used in the study included time taken for result turnaround and the costs associated with patient monitoring in the ED pending diagnosis. The scenarios tested were the use of hs-cTn POC for diagnosis with the turnaround time of 20 minutes versus hs-cTn testing in the central laboratory with the turnaround time of 60 to 90 minutes. The two tests were assumed to be equivalent in sensitivity and specificity.

RESULTS : The base case results indicate that if hs-cTn POC testing is used (versus a 60 minutes lab turnaround), it potentially saves £53.36 in Route 1, £ 76.72 in Route 2 and £ 65.47 in Route 3 per patient. By reducing time to result, it also helps in easing ED pressure as it enables rapid ruling-in and ruling-out of AMI patients. Savings per patient increase if the turnaround time of the laboratory test result takes 90 minutes.

CONCLUSIONS : This study concluded that the use of hs-cTn POC testing for rapid ruling on AMI for patients presenting with chest pain in the ED was cost-saving and reduced ED pressure.