Cost-effectiveness of prehospital high-sensitivity troponin i testing versus standard emergency department care in patients with suspected acute coronary syndrome in France
In brief
Prehospital troponin testing cut French 24-hour emergency costs by 83 euros per patient
In data from 737 adults with suspected acute coronary syndrome, a strategy starting with prehospital high-sensitivity troponin testing was linked to fewer emergency department visits and shorter stays; modeled prehospital and emergency department costs averaged 83 euros less per patient. The analysis covered only the first 24 hours and excluded inpatient and broader costs, so total system savings remain unknown.
- Journal
- Health economics review (Q1)
- Published
- 25 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Franck Maunoury, Raphaël Couvreur, Pierre Hausfater, Jérémy Guénézan
- PMID
- 42902060
- DOI
- 10.1186/s13561-026-00832-x
Why clinicians should know about it
- Picked for Emergency Medicine (paper of the day, 23 October 2026): Prehospital troponin triage may reduce ED attendance and length of
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).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.