• Ekaterine Popova, Pablo Alonso-Coello, Jesús Álvarez-García, Pilar Paniagua-Iglesias, Montserrat Rué-Monné, Miguel Vives-Borrás, Adria Font-Gual, Ignasi Gich-Saladich, Cecilia Martínez-Bru, Jordi Ordóñez-L... more lanos, and Misericordia Carles-Lavila. less
• From the IIB SANT PAU, Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain (EP, PA-C, IG-S), Centro Cochrane Iberoamericano, Barcelona, Spain (EP, PA-C), CIBER de Epidemiología y Salud Pública (CI... more BERESP), Madrid, Spain (PA-C, IG-S), Hospital de la Santa Creu i Sant Pau, Department of Cardiology, Barcelona, Spain (JÁ-G, MV-B), Hospital Universitario Ramon y Cajal, Department of Cardiology, Madrid, Spain (JÁ-G), Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain (JÁ-G), Hospital de la Santa Creu i Sant Pau, Department of Anaesthesia and Pain Management, Barcelona, Spain (PP-I, AF-G), Institut de Recerca Biomèdica de Lleida (IRBLleida), Department of Basic Medical Sciences, Lleida, Spain (MR-M), Research Group in Statistical and Economic Analysis in Health (GRAEES), Lleida, Spain (MR-M), Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Department of Cardiology, Palma, Balearic Islands, Spain (MV-B), Hospital de la Santa Creu i Sant Pau, Department of Clinical Epidemiology and Public Health, Barcelona, Spain (IG-S), Hospital de la Santa Creu i Sant Pau, Department of Biochemistry, Barcelona, Spain (CM-B, JO-L), Fundación para la Bioquímica Clínica y Patología Molecular. Barcelona, Spain (JO-L), Universitat Rovira i Virgili, Economy Faculty, Reus, Spain (MC-L), Centro de Investigación en Economía y Sostenibilidad (ECO-SOS), Reus, Spain (MC-L). less
• Eur J Anaesthesiol. 2023 Mar 1; 40 (3): 179189179-189.

BackgroundAbout 300 million surgeries are performed worldwide annually and this figure is increasing constantly. Peri-operative myocardial injury (PMI), detected by cardiac troponin (cTn) elevation, is a common cardiac complication of noncardiac surgery, strongly associated with short- and long-term mortality. Without systematic peri-operative cTn screening, most cases of PMI may go undetected. However, little is known about cost effectiveness of a systematic PMI screening strategy with high-sensitivity cardiac troponin T (hs-cTnT) after noncardiac surgery.ObjectiveTo assess, in patients with high cardiovascular risk, the cost-effectiveness of a systematic screening strategy using a hs-cTnT assay, to identify patients with PMI after major noncardiac surgery, compared with usual care.DesignCost-effectiveness analysis; single centre prospective cohort study.SettingSpanish University Hospital.PatientsFrom July 2016 to March 2019, we included 1477 consecutive surgical patients aged ≥65 or if <65, with documented history of cardiovascular disease or impaired renal function, who underwent major noncardiac surgery and required at least an overnight hospital stay. We excluded patients aged <65 years without cardiovascular disease, undergoing minor surgery, or with an expected <24 h hospital stays.InterventionsWe conducted a decision-tree analysis, comparing a systematic screening strategy measuring hs-cTnT before surgery, and at the 2nd and 3rd days after surgery vs. a usual care strategy. We considered a third-party payer perspective and the outcomes of both strategies in the short-term (30 days follow-up). Information about costs was expressed in Euros-2021. We calculated the incremental cost-effectiveness ratio (ICER) of the systematic hs-cTnT strategy, defined as the expected cost per any additional PMI detected, and explored the robustness of the model using deterministic and probabilistic sensitivity analysis.Main Outcome MeasuresICER of the systematic hs-cTnT screening strategy.ResultsThe ICER was €425 per any additionally detected PMI. The deterministic sensitivity analysis showed that a 15% variation in costs, and a 1% variation in the predictive values, had a minor impact over the ICER, except in case of the negative predictive value of the systematic hs-cTnT screening strategy. Monte Carlo simulations (probabilistic sensitivity analysis) showed that systematic hs-cTnT screening would be cost-effective in 100% of cases with a 'willingness to pay' of €780.ConclusionsOur results suggest that systematic peri-operative PMI screening with hs-cTnT may be cost-effective in the short-term in patients undergoing major noncardiac surgery. Economic evaluations, with a long-term horizon, are still needed.Trial RegistrationClinicaltrials.gov identifier: NCT03438448.Copyright © 2023 European Society of Anaesthesiology and Intensive Care. Unauthorized reproduction of this article is prohibited.

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