Gc Vijay S, Alshurafa Mohamad, Sturgess David J, Ting Joseph, Gregory Kye, Oliveira Gonçalves Ana Sofia, Whitty Jennifer A
Centre for Health Economics, University of York, York, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
BMJ Open. 2019 May 30;9(5):e023920. doi: 10.1136/bmjopen-2018-023920.
To estimate the cost implications of early angiography for patients with suspected non-ST elevation acute coronary syndrome (NSTEACS) using tissue Doppler imaging (TDI).
A decision tree model was used to synthesise data from the pilot study and literature sources. Sensitivity analyses tested the impact of assumptions incorporated into the analysis.
Emergency department (ED), Brisbane, Australia.
Patients with suspected NSTEACS.
TDI as a diagnostic tool for triaging patients within 4 hours of presentation in addition to conventional risk stratification, compared with conventional risk stratification alone.
Resource used for diagnosis and management were recorded prospectively and costed for 51 adults who had echocardiography within 24 hours of admission. Costs for conventional care were based on observed data. Cost estimates for the TDI intervention assumed patients classified as high risk at TDI (E/e'>14) progressed early to angiography with an associated 1-day reduction in length of stay.
Costs until discharge from the Australian healthcare perspective in 2016-2017 prices.
Findings suggest that using TDI as a diagnostic tool for triaging patients with suspected NSTEACS is likely to be cost saving by $A1090 (95% credible interval: $A573 to $A1703) per patient compared with conventional care. The results are mainly driven by the assumed reduction in length of stay due to the inclusion of early TDI in clinical decision-making.
This pilot study indicates that compared with conventional risk stratification, triaging patients presenting with suspected NSTEACS with TDI within 4 hours of ED presentation has potential cost savings. Findings assume a reduction in hospital stay is achieved for patients considered to be high risk at TDI. Larger, comparative studies with longer follow-up are needed to confirm the clinical effectiveness of TDI as a diagnostic strategy for NSTEACS, the assumed reduction in hospital stay and any cost saving.
使用组织多普勒成像（TDI）评估早期血管造影对疑似非ST段抬高急性冠状动脉综合征（NSTEACS）患者的成本影响。
采用决策树模型综合来自试点研究和文献来源的数据。敏感性分析测试了纳入分析的假设的影响。
澳大利亚布里斯班的急诊科。
疑似NSTEACS患者。
与仅采用传统风险分层相比，TDI作为一种诊断工具，在患者就诊4小时内除进行传统风险分层外，还用于对患者进行分类。
前瞻性记录用于诊断和管理的资源，并对51名入院24小时内接受超声心动图检查的成年人进行成本核算。传统护理的成本基于观察到的数据。TDI干预的成本估计假设，TDI分类为高危（E/e'>14）的患者早期进行血管造影，住院时间相应缩短1天。
从澳大利亚医疗保健角度以2016 - 2017年价格计算直至出院的成本。
研究结果表明，与传统护理相比，使用TDI作为诊断工具对疑似NSTEACS患者进行分类，每名患者可能节省1090澳元（95%可信区间：573澳元至1703澳元）。结果主要由临床决策中纳入早期TDI导致的住院时间缩短所驱动。
这项试点研究表明，与传统风险分层相比，在急诊科就诊4小时内使用TDI对疑似NSTEACS患者进行分类有潜在的成本节约。研究结果假设TDI高危患者的住院时间会缩短。需要进行更大规模、随访时间更长的比较研究，以确认TDI作为NSTEACS诊断策略的临床有效性、假设的住院时间缩短情况以及任何成本节约。
