Parameters and their distributions of the model of troponin T monitoring on the detection of myocardial injury after noncardiac surgery
| Parameter | Point estimate | Distribution | α/β or SE | Source |
|---|---|---|---|---|
| Health state | ||||
| True-negative troponin T monitoring | 91.18% | b | 5490/531 | VISION study (2) |
| True-positive troponin T monitoring | 8.39% | b | 505/5516 | VISION study (2) |
| False-negative troponin T monitoring | 0.07% | b | 4/6017 | VISION study (2) |
| False-positive troponin T monitoring | 0.37% | b | 22/5999 | VISION study (2) |
| True-negative standard care | 90.63% | b | 5457/564 | Residual |
| True-positive standard care | 1.52% | b | 91/5920 | VISION study (2)† |
| False-negative standard care | 6.94% | b | 418/5603 | VISION study (2)† |
| False-positive standard care | 0.92% | b | 55/5966 | Expert-based |
| Cost parameters* | ||||
| Electrocardiography | $11.05 | NA | — | Ontario Health Insurance Plan Schedule of Benefits (9) |
| Echocardiography | $208.80 | NA | — | Ontario Health Insurance Plan Schedule of Benefits (9) |
| Troponin T measurement (per measurement) | $18.00 | NA | — | Laboratory Reference Centre affiliated with Hamilton Health Sciences |
| Cardiologist consultation | $157 | NA | — | Ontario Health Insurance Plan Schedule of Benefits (10) |
| Cardiologist partial assessment | $31 | NA | — | Ontario Health Insurance Plan Schedule of Benefits (10) |
| Coronary angiography | $2903.99 | NA | — | Clement et al., (11) CanadianConsumer Price Index |
| Probability that troponin T level would exceed upper limit of normal in last scheduled measurement | 15.23% | b | 46/256 | VISION study (2) (patients with all 4 measurements) |
| Probability of angiography in patients who experience MINS | 0.99% | b | 5/500 | VISION study (2) |
| Probability of angiography in patients with symptomatic MINS | 5.41% | b | 4/70 | VISION study (2) |
| Probability of angiography in patients with false-positive troponin T monitoring | 4.55% | b | 1/21 | VISION study (2) |
| Probability of angiography in patients with false-negative troponin T monitoring | 25% | b | 1/3 | VISION study (2) |
| Cost of troponin monitoring true-negative | $72.00 | Log normal | 3.60 | Based on predefined diagnostic algorithms (see Methods) |
| Cost of troponin monitoring true-positive | $597.24 | Log normal | 27.39 | Based on predefined diagnostic algorithms (see Methods) |
| Cost of troponin monitoring false-negative | $1276.32 | Log normal | 41.73 | Based on predefined diagnostic algorithms (see Methods) |
| Cost of troponin monitoring false-positive | $605.75 | Log normal | 18.44 | Based on predefined diagnostic algorithms (see Methods) |
| Cost of standard care true-negative | $0.00 | NA | — | Based on predefined diagnostic algorithms (see Methods) |
| Cost of standard care true-positive | $734.27 | Log normal | 29.27 | Based on predefined diagnostic algorithms (see Methods) |
| Cost of standard care false-negative | $0.00 | NA | — | Based on predefined diagnostic algorithms (see Methods) |
| Cost of standard care false-positive | $58.10 | Log normal | 3.47 | Based on predefined diagnostic algorithms (see Methods) |
MINS = myocardial injury after noncardiac surgery; NA = not applicable; SE = standard error; VISION = Vascular Events in Noncardiac Surgery Patients Cohort Evaluation.
↵* In 2015 Canadian dollars.
↵† Proportion of cases of ischemic troponin T elevation; i.e., including false-negative troponin T monitoring.