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http://hdl.handle.net/11375/12658
Title: | MODEL-BASED COST-CONSEQUENCE ANALYSIS OF POSTOPERATIVE TROPONIN T SCREENING IN PATIENTS UNDERGOING NONCARDIAC SURGERY |
Authors: | Lurati, Buse AL Giovanna |
Advisor: | Devereaux, PJ Lamy, André Guyatt, Gordon |
Department: | Clinical Health Sciences (Health Research Methodology) |
Keywords: | economic evaluation; cost-consequence analysis; troponin T; noncardiac surgery; screening;Anesthesiology;Cardiology;Clinical Epidemiology;Health Services Research;Surgery;Anesthesiology |
Publication Date: | Oct-2012 |
Abstract: | <p>Introduction: Globally, more than 200 million patients undergo major non-cardiac surgery each year and more than 10 million patients will be exposed to postoperative myocardial ischemia, a condition strongly associated with 30-day mortality. The majority of these events go undetected without postoperative Troponin screening. Methods: We conducted a model-based cost-consequence analysis comparing a postoperative Troponin T screening vs. standard care in patients undergoing noncardiac surgery. In a first model, we evaluated the incremental number of detected perioperative myocardial infarctions and the incremental costs. A second model assessed the effect of the screening and consequent treatment on 1-year survival and the related cost. Model inputs based on the Vascular events In Non-cardiac Surgery patIents cOhort evaluatioN (VISION) Study, a large international cohort. We run probability sensitivity analyses with 5,000 iterations. We conducted extensive sensitivity analyses.</p> <p>Results: The cost to avoid missing an event amounted to CAD$ 5,184 for PMI and CAD$ 2,983 for isolated Troponin T. The cost-effectiveness of the postoperative Troponin screening was higher in patients’ subgroups at higher risk for PMI, e.g. patients undergoing urgent surgery. The incremental costs at 1 year of a postoperative PMI screening by 4 Troponin T measurements were CAD$ 169.20 per screened patient. The cost to prevent a death at 1 year amounted to CAD$ 96,314; however, there was relevant model uncertainty associated with the efficacy of the treatment in the 1-year model.</p> <p>Conclusion: Based on the estimated incremental cost per health gain, the implementation of a postoperative Troponin T screening after noncardiac surgery seems appealing, in particular in patients at high risk for perioperative myocardial infarction. However, decision-makers will have to consider it in terms of opportunity costs, i.e. in relation to the cost-effectiveness of other potential programs within the broader health care context.</p> |
URI: | http://hdl.handle.net/11375/12658 |
Identifier: | opendissertations/7525 8587 3354342 |
Appears in Collections: | Open Access Dissertations and Theses |
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fulltext.pdf | 1.52 MB | Adobe PDF | View/Open |
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