PMID- 31152027
OWN - NLM
STAT- MEDLINE
DCOM- 20200430
LR  - 20200430
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 9
IP  - 5
DP  - 2019 May 30
TI  - Cost-minimisation analysis alongside a pilot study of early Tissue Doppler 
      Evaluation of Diastolic Dysfunction in Emergency Department Non-ST Elevation 
      Acute Coronary Syndromes (TEDDy-NSTEACS).
PG  - e023920
LID - 10.1136/bmjopen-2018-023920 [doi]
LID - e023920
AB  - OBJECTIVE: To estimate the cost implications of early angiography for patients 
      with suspected non-ST elevation acute coronary syndrome (NSTEACS) using tissue 
      Doppler imaging (TDI). DESIGN: 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. SETTING: Emergency 
      department (ED), Brisbane, Australia. PARTICIPANTS: Patients with suspected 
      NSTEACS. INTERVENTIONS: 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. DATA SOURCES: 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. PRIMARY OUTCOME MEASURES: 
      Costs until discharge from the Australian healthcare perspective in 2016-2017 
      prices. RESULTS: 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. CONCLUSIONS: 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.
CI  - (c) Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Gc, Vijay S
AU  - Gc VS
AUID- ORCID: 0000-0003-0365-2605
AD  - Centre for Health Economics, University of York, York, UK.
AD  - Norwich Medical School, University of East Anglia, Norwich, UK.
FAU - Alshurafa, Mohamad
AU  - Alshurafa M
AD  - Mater Research Institute, University of Queensland (MRI-UQ), South Brisbane, 
      Queensland, Australia.
FAU - Sturgess, David J
AU  - Sturgess DJ
AUID- ORCID: 0000-0002-4364-0038
AD  - Mater Research Institute, University of Queensland (MRI-UQ), South Brisbane, 
      Queensland, Australia.
FAU - Ting, Joseph
AU  - Ting J
AD  - Mater Research Institute, University of Queensland (MRI-UQ), South Brisbane, 
      Queensland, Australia.
FAU - Gregory, Kye
AU  - Gregory K
AD  - Mater Research Institute, University of Queensland (MRI-UQ), South Brisbane, 
      Queensland, Australia.
FAU - Oliveira Goncalves, Ana Sofia
AU  - Oliveira Goncalves AS
AD  - Norwich Medical School, University of East Anglia, Norwich, UK.
FAU - Whitty, Jennifer A
AU  - Whitty JA
AD  - Norwich Medical School, University of East Anglia, Norwich, UK.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20190530
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Acute Coronary Syndrome/*diagnostic imaging/*economics/physiopathology
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - *Costs and Cost Analysis
MH  - Diastole
MH  - *Echocardiography, Doppler
MH  - Emergency Service, Hospital
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pilot Projects
MH  - Prospective Studies
PMC - PMC6549746
OTO - NOTNLM
OT  - acute coronary syndrome
OT  - cost-minimisation
OT  - economic evaluation
OT  - tissue doppler imaging
COIS- Competing interests: None declared.
EDAT- 2019/06/04 06:00
MHDA- 2020/05/01 06:00
PMCR- 2019/05/30
CRDT- 2019/06/02 06:00
PHST- 2019/06/02 06:00 [entrez]
PHST- 2019/06/04 06:00 [pubmed]
PHST- 2020/05/01 06:00 [medline]
PHST- 2019/05/30 00:00 [pmc-release]
AID - bmjopen-2018-023920 [pii]
AID - 10.1136/bmjopen-2018-023920 [doi]
PST - epublish
SO  - BMJ Open. 2019 May 30;9(5):e023920. doi: 10.1136/bmjopen-2018-023920.