Cost-Effectiveness of Introducing Point-of-Care Test for Detection of Level of Glycogen Phosphorylase in Early Diagnostic Algorithm of Acute Coronary Syndrome

Abstract

Background: The detection of specific biomarkers in the early phase of acute coronary syndrome (ACS) is important for the early diagnosis and appropriate management of patients with ACS. Objectives: To estimate the cost-effectiveness of introducing a diagnostic point-ofcare (POC) test for determining the levels of glycogen phosphorylase BB isoform (GPBB) in a standard diagnostic algorithm for the early diagnosis of ACS within the health system of the Republic of Serbia. Methods: The probabilistic decision-tree model was constructed for patients with nontraumatic chest pain comparing the use of standard diagnostic procedure, physical examination, and electrocardiogram monitoring with the use of a diagnostic test for the detection of the levels of specific biomarkers. The perspective of the health care services purchaser (the Republic Institute for Health Insurance, Serbia) was used in the model, and only direct costs were taken into account. The time horizon was set at one treatment episode of ACS, and the discount rate was not included because of the short length of the time horizon. Results: Using the GPBB POC test in comparison with not using it in the early diagnosis of ACS results in a significant reduction in the cost per treatment episode (10,034.48 Ϯ 7,283.80 Serbian dinar [RSD]), increase in the number of survivors per 1000 treatment episodes (16 Ϯ 18), decrease in the number of hospitalizations per 1000 treatment episodes (104 Ϯ 44), and decrease in the number of performed coronarographies per 1000 treatment episodes (22 Ϯ 19). The costs per hospitalization avoided (incremental cost-effectiveness ratio) were À145,887.57 Ϯ 5,271.54 RSD, and the costs per coronarography avoided were À137,295.68 Ϯ 4,681.05 RSD. Conclusions: In the circumstances of limited health resources, reducing hospitalizations and decreasing unnecessary treatments and invasive diagnostic procedures by a GPBB POC test could be an effective way to improve the economic status of other Balkan countries with limited health care budgets.

Model-based economic evaluations of diagnostic point of care tests were rarely fit for purpose

“…The introduction of a POCT changed the location of testing in eight models (26,28,41,53,72,85,89,91) (Table 3). This was predominantly a move from secondary to primary care settings, with one model examined the provision of testing in a pharmacy setting (28).…”

“…Cost advantages for POCT arose from fewer visits to healthcare providers to receive results, less clinician time to conduct the test and shorter length of stay due to faster decision making and treatment initiation(23, 24, 26, 28-36, 41, 44, 60, 83, 84, 87). Reduced treatment or testing costs were observed as a result of avoiding presumptive treatment, additional tests and the need to treat disease which had progressed(24,26,27, 31,33,35, 37,41,43, 44,87).…”