Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care

Michelle Kip, Hendrik Koffijberg, Ron Kusters, Buntinx Frank, Jan Glatz, Robert Willemsen, the 'RAPIDA'-study team, Dinant GeertJan

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on ‘international data’, at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.
Original languageEnglish
Pages (from-to)176-188
Number of pages13
JournalPrimary health care research & development
Volume19
Issue number2
DOIs
Publication statusPublished - Mar 2018

Keywords

  • biomarkers
  • cardiovascular disease
  • clinical decision rule
  • cost effects
  • emergency medicine
  • primary care
  • ACUTE CORONARY SYNDROME
  • ACUTE MYOCARDIAL-INFARCTION
  • RESPIRATORY-TRACT INFECTIONS
  • COMPARATIVE FAMILY MEDICINE
  • TRANSITION PROJECT DATA
  • PROTEIN H-FABP
  • GENERAL-PRACTICE
  • EMERGENCY-DEPARTMENT
  • DIAGNOSTIC-VALUE
  • HEART-DISEASE

Cite this

Kip, Michelle ; Koffijberg, Hendrik ; Kusters, Ron ; Frank, Buntinx ; Glatz, Jan ; Willemsen, Robert ; 'RAPIDA'-study team, the ; GeertJan, Dinant. / Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care. In: Primary health care research & development. 2018 ; Vol. 19, No. 2. pp. 176-188.
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abstract = "The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on ‘international data’, at least a 29{\%} reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10{\%} relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.",
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author = "Michelle Kip and Hendrik Koffijberg and Ron Kusters and Buntinx Frank and Jan Glatz and Robert Willemsen and {'RAPIDA'-study team}, the and Dinant GeertJan",
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Early health technology assessment of future clinical decision rule aided triage of patients presenting with acute chest pain in primary care. / Kip, Michelle ; Koffijberg, Hendrik; Kusters, Ron; Frank, Buntinx; Glatz, Jan; Willemsen, Robert; 'RAPIDA'-study team, the; GeertJan, Dinant.

In: Primary health care research & development, Vol. 19, No. 2, 03.2018, p. 176-188.

Research output: Contribution to journalArticleAcademicpeer-review

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AU - Kip, Michelle

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AU - Willemsen, Robert

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AB - The objective of the paper is to estimate the number of patients presenting with chest pain suspected of acute coronary syndrome (ACS) in primary care and to calculate possible cost effects of a future clinical decision rule (CDR) incorporating a point-of-care test (PoCT) as compared with current practice. The annual incidence of chest pain, referrals and ACS in primary care was estimated based on a literature review and on a Dutch and Belgian registration study. A health economic model was developed to calculate the potential impact of a future CDR on costs and effects (ie, correct referral decisions), in several scenarios with varying correct referral decisions. One-way, two-way, and probabilistic sensitivity analyses were performed to test robustness of the model outcome to changes in input parameters. Annually, over one million patient contacts in primary care in the Netherlands concern chest pain. Currently, referral of eventual ACS negative patients (false positives, FPs) is estimated to cost €1,448 per FP patient, with total annual cost exceeding 165 million Euros in the Netherlands. Based on ‘international data’, at least a 29% reduction in FPs is required for the addition of a PoCT as part of a CDR to become cost-saving, and an additional €16 per chest pain patient (ie, 16.4 million Euros annually in the Netherlands) is saved for every further 10% relative decrease in FPs. Sensitivity analyses revealed that the model outcome was robust to changes in model inputs, with costs outcomes mainly driven by costs of FPs and costs of PoCT. If PoCT-aided triage of patients with chest pain in primary care could improve exclusion of ACS, this CDR could lead to a considerable reduction in annual healthcare costs as compared with current practice.

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KW - TRANSITION PROJECT DATA

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KW - HEART-DISEASE

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