OBJECTIVES: Emergency department (ED) overcrowding is a widespread problem associated with avoidable patient harm. Point-of-care testing (POCT) enables more rapid clinical decision-making in the process of diagnosis, treatment choice and monitoring, thus offering a potential solution to crowding challenges in ED. The purpose of this study was to perform a systematic review of the health economic evidence of POCT in ED.

METHODS: MEDLINE and EMBASE were systematically searched for articles published from 2010 until March 2023. All economic evaluations (EEs) of POCT in ED were included. Publications not in English were excluded.

RESULTS: 11 EEs of POCT in ED were identified. The EEs were different in design (5 were cost-effectiveness analyses, 2 cost-utility analyses, 4 cost-consequence analyses, and 4 were modelling studies while 7 were trial-based). All EEs showed an improvement in efficiency and/or patient quality at the ED, however, this was measured differently (4 measured the improvement in time-to-diagnosis, 6 measured improvement in length of stay (LOS) at the ED, 2 estimated the improvement in avoidable patient harm in QALY and 8 other endpoints). The studies reported that the increased efficiency in ED benefitted other parts of the hospital dependent, however full realization of the potential benefits from POCT was limited by local organizational circumstances and the design of the clinical study. 3 reported POCT was dominant (i.e. both more effective and cheaper) 6 concludes POCT was cost-effective, while 2 had no clear conclusion.

CONCLUSIONS: Evidence suggests POCT may be cost-effective in ED. The full potential of POCT may be difficult to realize in short-term clinical trials because it requires the “organization to work” systematically and iteratively with implementation methods. Future health economic research should incorporate the full economic impact of POCT considering patient benefits, direct and indirect costs, and the potential for improving patient pathways and ED performance through process redesign.