Key result
POC hs-cTnI is cost-neutral compared with central laboratory testing for index and 30-day costs.
Why the study?
Point-of-care hs-cTn assays offer rapid turnaround within 0/1-hour accelerated diagnostic protocols, but higher per-test costs raise concerns about overall economic impact, and randomised evaluations of real-world implementation remain limited.
Does implementing point-of-care hs-cTnI testing within a 0/1-hour accelerated diagnostic protocol reduce total index admission costs and 30-day specialist care costs in adults presenting with suspected acute coronary syndrome?
RCT (n=1,494)
1:1
No
Does implementing point-of-care hs-cTnI testing within a 0/1-hour accelerated diagnostic protocol reduce total index admission costs and 30-day specialist care costs in adults presenting with suspected acute coronary syndrome?
Implementing point-of-care hs-cTnI testing within a 0/1-hour accelerated diagnostic protocol is cost-neutral at both index admission and 30 days compared to central laboratory testing, despite higher per-test costs.
Supports POC hs-cTnI adoption in 0/1-hour protocols without cost increase; confirms economic equivalence to central laboratory testing in suspected ACS.
Background Point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) assays provide rapid turnaround times and are increasingly considered for use within guideline recommended 0/1-hour accelerated diagnostic protocols (ADPs). However, higher per-test costs raise concerns regarding overall economic impact. Randomised evaluations of real-world implementation remain limited. Purpose To assess the effect of implementing POC hs-cTnI testing within a 0/1-hour ADP on total index admission costs and 30-day specialist care costs. Methods This pre-specified secondary analysis of a single-centre randomised controlled trial included 1,494 adults presenting with suspected acute coronary syndrome. Participants were randomised 1:1 to 0/1-hour POC hs-cTnI testing or central laboratory hs-cTnT testing. Costs were estimated from the healthcare provider perspective using Norwegian patient-level costing and Diagnosis-Related Group frameworks. Resource use was extracted from electronic hospital records. Unadjusted mean cost differences were estimated using non-parametric bootstrap resampling. To account for potential confounders, a generalised linear model with gamma distribution and log link was fitted, adjusting for age, sex, adjudicated diagnosis, and disposition. Results Mean total index admission cost was €3,083 in the POC group and €3,126 in the control group (mean difference −€43; 95%CI −510 to 423). In adjusted analyses, costs remained similar between groups (adjusted mean difference €11; 95%CI −183 to 204). Mean total specialist care costs from admission to 30 days were €3,517 in the POC group and €3,413 in the control group (mean difference €105; 95%CI −405 to 615). Cost patterns were consistent across diagnostic and disposition subgroups. Conclusion In this randomised evaluation, implementation of POC hs-cTnI testing within a 0/1-hour ADP was cost-neutral at both index admission and 30 days. Despite higher per-test costs, overall episode costs were not increased. These findings suggest that biomarker pricing alone is unlikely to be a major driver of total healthcare expenditure when POC hs-cTn testing is integrated into emergency department pathways.
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Thulin et al. (2026) conducted an RCT in Suspected acute coronary syndrome (n=1,494). 0/1-hour point-of-care hs-cTnI testing vs. Central laboratory hs-cTnT testing was evaluated on Total index admission costs (€) (MD -43, 95% CI -510 to 423). 0/1-hour POC hs-cTnI testing was cost-neutral vs central laboratory hs-cTnT for index admission costs (€3,083 vs €3,126; MD -€43; 95% CI -510 to 423) and 30-day costs (MD €105; 95% CI -405 to 615).
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