ECONOMIC EVALUATION OF HARTC 2.0 TRIAL: PREHOSPITAL ACS TRIAGE USING A MODIFIED HEART SCORE WITH POINT-OF-CARE HS-CTNI
Author(s)
Anne Catherine M.h. van der Lande, MSc1, Nina M Diederiks, MSc1, Enrico R. de Koning, MD, PhD1, Jan Bosch, RN1, Fred P.H.T.M. Romijn, .1, Elske van den Akker-van Marle, PhD1, Reza Alizadeh Dehnavi, MD2, Wouter J. Tietge, MD3, Bart J.A. Mertens, PhD1, J. Wouter Jukema, MD, PhD1, Christa M. Cobbaert, EuSpLM, PhD1, Martin J. Schalij, MD, PhD1, Mark J. Boogers, MD, PhD1.
1Leiden University Medical Center (LUMC), Leiden, Netherlands, 2Groene Hart Ziekenhuis, Gouda, Netherlands, 3Alrijne Ziekenhuis, Leiderdorp, Netherlands.
1Leiden University Medical Center (LUMC), Leiden, Netherlands, 2Groene Hart Ziekenhuis, Gouda, Netherlands, 3Alrijne Ziekenhuis, Leiderdorp, Netherlands.
OBJECTIVES: Chest pain accounts for approximately 10% of emergency department (ED) visits, while most patients with suspected non-ST-elevation acute coronary syndrome (ACS) ultimately do not have ACS. Improved prehospital risk stratification may reduce unnecessary ED visits and hospital admissions while ensuring timely care for higher-risk patients. The HARTc 2.0 randomized controlled trial evaluates a prehospital triage strategy using a modified HEART score incorporating point-of-care (POC) high-sensitivity cardiac troponin I (hs-cTnI). This study aims to evaluate the economic consequences of this strategy compared with standard care.
METHODS: This economic evaluation is embedded in the multicenter randomized HARTc 2.0 trial. Adult patients presenting to emergency medical services with chest pain and suspected ACS are randomized (1:1) to either prehospital triage using a modified HEART score with POC hs-cTnI testing and a 0/2-hour algorithm, or standard care using the HEAR score with in-hospital hs-cTnT testing following a 0/1-hour algorithm. The analysis is conducted from a societal perspective with a 30-day time horizon. Resource use includes ambulance deployment, ED visits, hospital admissions, diagnostic testing, and revascularization. Health-related quality of life is measured using the EQ-5D-5L at baseline and 30 days, and quality-adjusted life years (QALYs) are calculated using the area-under-the-curve method. Costs are valued using Dutch reference prices.
RESULTS: At the time of submission, patient inclusion and data collection are ongoing. The analysis will compare health care utilization, costs, QALYs, and incremental cost-effectiveness between triage strategies. Key outcomes include rates of non-transport after EMS assessment, ED utilization, hospital admissions, and downstream diagnostic and therapeutic resource use. Uncertainty will be assessed using nonparametric bootstrapping and presented in cost-effectiveness acceptability curves.
CONCLUSIONS: This economic evaluation will inform decisions on implementing prehospital diagnostic strategies to improve efficiency and sustainability of acute cardiac care pathways.
METHODS: This economic evaluation is embedded in the multicenter randomized HARTc 2.0 trial. Adult patients presenting to emergency medical services with chest pain and suspected ACS are randomized (1:1) to either prehospital triage using a modified HEART score with POC hs-cTnI testing and a 0/2-hour algorithm, or standard care using the HEAR score with in-hospital hs-cTnT testing following a 0/1-hour algorithm. The analysis is conducted from a societal perspective with a 30-day time horizon. Resource use includes ambulance deployment, ED visits, hospital admissions, diagnostic testing, and revascularization. Health-related quality of life is measured using the EQ-5D-5L at baseline and 30 days, and quality-adjusted life years (QALYs) are calculated using the area-under-the-curve method. Costs are valued using Dutch reference prices.
RESULTS: At the time of submission, patient inclusion and data collection are ongoing. The analysis will compare health care utilization, costs, QALYs, and incremental cost-effectiveness between triage strategies. Key outcomes include rates of non-transport after EMS assessment, ED utilization, hospital admissions, and downstream diagnostic and therapeutic resource use. Uncertainty will be assessed using nonparametric bootstrapping and presented in cost-effectiveness acceptability curves.
CONCLUSIONS: This economic evaluation will inform decisions on implementing prehospital diagnostic strategies to improve efficiency and sustainability of acute cardiac care pathways.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE316
Topic
Economic Evaluation
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)