clinico-economical impact of hta implementation on chest pain diagnostic markers
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Clinico-Economical Impact of HTA Implementation on chest pain diagnostic Marker
Dott . Antonella PuglieseU.O. Educati on and Clinical GovernanceS.Camillo-Forlanini Hospital, Rome, Italy
WHY AN HTA ON CHEST PAIN DIAGNOSTIC MARKERS PRESCRIPTION?
TECHNOLOGY IMPROVEMENT GUIDELINE MODIFICATION
TROPONIN I and T
MAIN DIAGNOSTIC MARKERS OF CHEST PAIN:
CK-MBMYOGLOBIN
METHODOLOGY OF TECHNOLOGY STUDYTroponin CK MB Myoglobin BNP CRP
Chest pain (probably heart related) X1
STEMI X2 X3
NSTEMI X2 X3
Acute instable angina X2 X3
Major trauma X
Reperfusion syndrome X
Myo - pericarditis X2 X3 X
Yes,It should be used
X3 = note
Technologies
No Indication
Clinical presentations
S. Camillo- Forlanini U.O. Formazione e Governo Clinico
Troponin CK MB Myoglobin BNP CRP
Chest pain (probably heart related) X1
STEMI X2 X3
NSTEMI X2 X3
Acute instable angina X2 X3
Major trauma X
Reperfusion syndrome X
Myo - pericarditis X2 X3 X
METHODOLOGY OF TECHNOLOGY STUDY
INTERVENTION OUTCOME GRAPHICS
JanuaryFebrauryM
archAprilM
ayJuneJulyAugustSeptem
berOctoberNovem
berDecem
ber
0
500
1000
1500
2000
FIRST AID REQUESTS NUMBER
MyoglobinCK-MBTroponin
CLINICAL IMPACT VERIFICATION THROUGH STATISTICAL ANALYSIS
Admitted Not Admitted Total Accesses
After Intervention 539 1590 2129
Before Intervention 830 2487 3317
Total 1369 4077 5446
Confidence Level 99%
Value Confidence Interval 99%
Relative Risk (RR) 1,012 0,894 1,144
Absolute Risk Reduction -0,003 -0,034 0,028
Relative Risk Reduction -0,012 -0,144 0,106
CONFIDENCE INTERVAL CONTAINS
NUMBER ONE
NULL HYPOTESIS IS CONFIRMED
THERE IS NOT ANY DIFFERENCE
BETWEEN BEFORE AND AFTER THE INTERVENTION
Myoglobin exams One Year Estimation One Year Cost
First Aid After intervention 444 1.621
Before intervention 13.816 50.428
Rest of the Hospital After intervention 581 2.120
Before intervention 18.076 65.977
Cost per kit (euro) Number of tests/
1 kitEffective tests Number /
1 KitReagent Cost or Single test Cost
Myoglobin 766 250 210 3,65
ECONOMICAL ANALYSIS
S. Camillo- Forlanini U.O. Formazione e Governo Clinico
We started from an average of about 1100 myoglobin / month / First Aid tests.The intervention led to an inappropriateness reduction of 96.78%.
First Aid Rest of the Hospital
Total Estimated Saving
48.808 + 63.857 = 112.665 EURO /Year
APPROPRIATENESS AND ECONOMICAL IMPACT
