Cost-effectiveness of prehospital high-sensitivity troponin i testing versus standard emergency department care in patients with suspected acute coronary syndrome in France
6 affiliations
- 1STATESIA, Le Mans, France. [email protected].
- 2Le Mans University, GAINS Laboratory, IRA Institute, Le Mans, France. [email protected].
- 3Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Poitiers, France.
- 4Point of Care in Emergency Room (POCER) Network, ANR-24-DIME-0003, University Hospital of Bordeaux, Bordeaux France, Biochemistry Laboratory - Hormone Testing, University Hospital of Nice, University of Nice Côte d'Azur, Pasteur 1, Nice, F-06000, France.
- 5School of Medicine and Pharmacy, University of Poitiers, Poitiers, France.
- 6INSERM U1070, Pharmacology of Anti-Infective Drugs, Poitiers, France.
Abstract
Background Prehospital 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. Methods We 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). Results Among 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). Conclusions Within 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 registration The VALIDATE study is registered with ClinicalTrials.gov (NCT04950244).
Related
- Prehospital qSOFA Is Associated with 30-Day Mortality Within Emergency Department Triage Strata in Ambulance-Transported Adults with Suspected Infection: An Exploratory Three-Year Retrospective Cohort Study
- The effect of preload on Doppler systolic time in a large emergency department cohort with suspected sepsis
- The effectiveness of point of care high sensitivity troponin testing to improve Emergency Department flow: a multi-centre controlled interrupted time series
- Whole-blood transcriptomic findings in emergency department patients with suspected cannabinoid hyperemesis syndrome: a pilot study.
- Post-Traumatic Amnesia Testing for Suspected Concussion in the Emergency Department: A Retrospective Study.
BibTeX
@article{maunoury2026costeffectiveness,
title = {{Cost-effectiveness of prehospital high-sensitivity troponin i testing versus standard emergency department care in patients with suspected acute coronary syndrome in France}},
author = {Franck Maunoury and Raphaël Couvreur and Pierre Hausfater and Jérémy Guénézan},
journal = {Health Economics Review},
year = {2026},
month = jul,
doi = {10.1186/s13561-026-00832-x},
url = {https://univ-lemans.hal.science/hal-05735385v1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Cost-effectiveness of prehospital high-sensitivity troponin i testing versus standard emergency department care in patients with suspected acute coronary syndrome in France
AU - Franck Maunoury
AU - Raphaël Couvreur
AU - Pierre Hausfater
AU - Jérémy Guénézan
PY - 2026
DA - 2026/07/01
JO - Health Economics Review
DO - 10.1186/s13561-026-00832-x
UR - https://univ-lemans.hal.science/hal-05735385v1
AB - Background Prehospital 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. Methods We 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). Results Among 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). Conclusions Within 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 registration The VALIDATE study is registered with ClinicalTrials.gov (NCT04950244).
SN - 2191-1991
ER -