Cost-effectiveness of prehospital high-sensitivity troponin i testing versus standard emergency department care in patients with suspected acute coronary syndrome in France.

backgroundPrehospital point-of-care high-sensitivity cardiac troponin I (hs-cTnI) may support earlier triage of adults with suspected acute coronary syndrome (ACS). We assessed its short-term economic consequences compared with standard emergency department (ED)-based care in France.

methodsWe developed a decision-analytic, continuous-time semi-Markov model over a 24-hour horizon using individual patient data from the prospective, multicentre, double-blinded cohort study (VALIDATE) conducted across four French hospitals (July 2021-May 2024; n = 737). The reference analysis adopted a restricted prehospital-and-ED perspective covering measured medical and paramedical resources from first emergency medical service contact through ED disposition (states 1-3). A complementary database audit searched for patients recorded with less than 24 h of follow-up in an extended "prehospital, emergency department and hospital" setting. None were identified; inpatient, intensive care unit (ICU), coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) costs were therefore excluded from the reference-case totals. The initial hs-cTnI H0 sample was obtained before hospital arrival, whereas subsequent H1 or H3 samples, when required, were intended to be collected after arrival. Costs were reported in 2025 euros. Sampling uncertainty was assessed using 1,000 non-parametric bootstrap replications and scenario analyses examined clinically relevant subgroups (> 3 h since symptom onset; availability of a prehospital HEART score).

resultsAmong 737 participants (mean age 65.4 years; 58.8% men), 77 (10.4%) had non-ST-segment elevation myocardial infarction. ED attendance was lower with hs-cTnI than with standard care (90.9% [95% CI 88.6-92.8] vs. 96.7% [95% CI 95.2-97.8]; absolute difference - 5.8% points [95% CI - 9.2 to - 2.4]; P < 0.001). Among ED attendees, mean ED length of stay was 1.63 h versus 2.76 h (P < 0.001). Mean prehospital-and-ED cost per patient was €185.24 with hs-cTnI and €268.55 with standard care, a saving of €83.31 ([95% CI 70.81-96.60]; P < 0.001).

conclusionsWithin the restricted 24-hour prehospital-and-ED perspective supported by the available patient-level data, a strategy beginning with prehospital hs-cTnI testing was associated with fewer ED attendances, shorter ED stays and lower costs. Longer-term evaluations are planned because these findings do not establish system-wide for inpatient, wider organisational, patient and societal costs.

trial registrationThe VALIDATE study is registered with ClinicalTrials.gov (NCT04950244).