Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment
Authors' conclusion
Prehospital point-of-care troponin and paramedic risk stratification for patients with acute chest pain could result in substantial cost savings.
Study context
- Population
- Adults attended by ambulance with acute chest pain without ST-segment elevation, Victoria, Australia, 2015–2019
- Participants
- 188,551 adults
- Comparison
- Prehospital point-of-care troponin and paramedic risk stratification vs existing care
- Outcome
- Estimated mean annualized statewide costs for acute chest pain
Methodological detailscost-minimization analysis, decision tree models, multivariable probabilistic sensitivity analysis, 50 000 Monte Carlo iterations, Prehospital pathway probabilities derived from a literature review
- Cost-minimization analysis
- Decision tree models
- Multivariable probabilistic sensitivity analysis, 50 000 Monte Carlo iterations
- Prehospital pathway probabilities derived from a literature review
Main finding
As reported in the abstract
Total annual cost vs existing care
Cost savings
6.45 $ million
95% UI 0.59–16.52
Without prehospital discharge · 95% UI; lower in 94.1% of iterations
Cost savings
42.84 $ million
95% UI 19.35–72.26
With prehospital discharge · 95% UI; lower in 100% of iterations
Further findings
| Outcome | Without prehospital discharge | With prehospital discharge |
|---|---|---|
| Annualized infrastructure and staffing costs (5-year device life span)Incl. virtual ED costs for prehospital discharge pathway | 2.27 $ million | 4.60 $ million |
Original publication
Chest Pain Management Using Prehospital Point-of-Care Troponin and Paramedic Risk Assessment. JAMA Intern Med. Published 1 March 2023. doi:10.
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