Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting
Sammanfattning
Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing
(POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective
observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT
and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients ? 35 years of
age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness
and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have
commenced or worsened during the previous seven days. Main outcome measures. Emergency
referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were
collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients
with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without
POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently
referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%)
from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%)
from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed
cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without
POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in
primary care may be cost saving but at the expense of missed cases.