2022 Fiscal Year Final Research Report
Diagnostic and Cost Efficiency of the 0h/1h Rule-out and Rule-in Algorithm for Patients With Chest Pain in the Emergency Department
| Project/Area Number |
18K09954
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Review Section |
Basic Section 58010:Medical management and medical sociology-related
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| Research Institution | Juntendo University |
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Principal Investigator |
Inoue Kenji 順天堂大学, 医学部, 准教授 (80317388)
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| Co-Investigator(Kenkyū-buntansha) |
渡邊 亮 神奈川県立保健福祉大学, ヘルスイノベーション研究科, 准教授 (90756173)
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| Project Period (FY) |
2018-04-01 – 2023-03-31
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| Keywords | 急性冠症候群 / 0/1-hアルゴリズム / 医療費 / 高感度トロポニン |
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| Outline of Final Research Achievements |
Background: This study aimed to understand the economic impact of the 0h/1h algorithm with high-sensitivity cardiac troponin assays for chest pain triage. Methods and Results: A cost-effectiveness analysis was conducted with 472 patients following the 0/1-h algorithm (Hospital A) and 427 patients following the point of care testing (Hospital B). The clinical outcome was all-cause mortality or subsequent myocardial infarction within 30 days. The sensitivity and specificity for the clinical outcome were 100% and 95.0% in Hospital A and 92.9% and 89.8% in Hospital B. Assuming the diagnostic accuracy of the 0/1-h algorithm was implemented in Hospital B, the number of urgent coronary angiographies would decrease by 50%. Thus, implementation of the 0/1-h algorithm could reduce medical costs by 4,033,874 Japanese Yen (JPY) (9,447 JPY per patient) in Hospital B.Conclusion: The 0/1-h algorithm is efficient not only for risk stratification, but also for medical cost reduction.
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| Free Research Field |
循環器内科学
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| Academic Significance and Societal Importance of the Research Achievements |
胸痛を主訴に救急外来受診する患者には10人から15人に1人の確率で急性冠症候群が診断される。そのため安全面を考慮し緊急冠動脈造影検査目的での入院は少なくない。しかしながら救急対応は加算がつくため通常入院に比べ医療費がかかる。しかしながら救急外来で高感度トロポニンを来院時と1時間後に2度測定するだけで患者の層別化が容易にできる。結果、緊急入院を避けることができ、不必要な入院を減らせる可能性がある。本研究により、救急での時間と費用の削減効果が明示できれば、他の新規検査法の導入へのモデルとなる。
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