Article Text

other Versions

Download PDFPDF
Healthcare cost burden of acute chest pain presentations
  1. Luke Dawson1,2,
  2. Emily Nehme2,3,
  3. Ziad Nehme2,3,
  4. Ella Zomer2,
  5. Jason Bloom1,4,
  6. Shelley Cox2,3,
  7. David Anderson3,5,
  8. Michael Stephenson3,
  9. Jeffrey Lefkovits6,
  10. Andrew Taylor1,7,
  11. David Kaye1,4,
  12. Louise Cullen8,
  13. Karen Smith3,
  14. Dion Stub1,2,4
  1. 1Department of Cardiology, Alfred Hospital, Prahran, Victoria, Australia
  2. 2Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  3. 3Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia
  4. 4Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
  5. 5Intensive Care and Hyperbaric Medicine, Alfred Health, Melbourne, Victoria, Australia
  6. 6Department of Cardiology, Melbourne Health, Parkville, Victoria, Australia
  7. 7Department of Medicine, Monash University, Melbourne, Victoria, Australia
  8. 8Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
  1. Correspondence to Dr Luke Dawson, Cardiology, Alfred Hospital, Prahran, VIC 3004, Australia; lukepdawson1{at}


Background This study aimed to estimate the direct healthcare cost burden of acute chest pain attendances presenting to ambulance in Victoria, Australia, and to identify key cost drivers especially among low-risk patients.

Methods State-wide population-based cohort study of consecutive adult patients attended by ambulance for acute chest pain with individual linkage to emergency and hospital admission data in Victoria, Australia (1 January 2015–30 June 2019). Direct healthcare costs, adjusted for inflation to 2020–2021 ($A), were estimated for each component of care using a casemix funding method.

Results From 241 627 ambulance attendances for chest pain during the study period, mean chest pain episode cost was $6284, and total annual costs were estimated at $337.4 million ($68 per capita per annum). Total annual costs increased across the period ($310.5 million in 2015 vs $384.5 million in 2019), while mean episode costs remained stable. Cardiovascular conditions (25% of presentations) were the most expensive (mean $11 523, total annual $148.7 million), while a non-specific pain diagnosis (49% of presentations) was the least expensive (mean $3836, total annual $93.4 million). Patients classified as being at low risk of myocardial infarction, mortality or hospital admission (Early Chest pain Admission, Myocardial infarction, and Mortality (ECAMM) score) represented 31%–57% of the cohort, with total annual costs estimated at $60.6 million–$135.4 million, depending on the score cut-off used.

Conclusions Total annual costs for acute chest pain presentations are increasing, and a significant proportion of the cost burden relates to low-risk patients and non-specific pain. These data highlight the need to improve the cost-efficiency of chest pain care pathways.

  • non-trauma
  • emergency ambulance systems
  • costs and cost analysis
  • acute coronary syndrome

Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.

View Full Text


  • Handling editor Richard Body

  • Twitter @Ziad_Nehme1

  • Contributors Concept and design of study: DS, KS, LD, EN and ZN; acquisition of data: DS, KS, DK, LD, EN, ZN and SC; analysis of data: LD, EN, SC and EZ; drafting of the manuscript: LD, DS, KS, ZN and EN; revision of the manuscript: JB, SC, DA, MS, JL, AT, DK, LC and EZ; approval of the final manuscript: LD, EN, ZN, JB, SC, DA, MS, JL, AT, DK, KS, DS, LC and EZ. LD and DS accept full responsibility for the finished work and conduct of the study, had access to the data, and controlled the decision to publish. LD and DS act as guarantors.

  • Funding LD is supported by National Health and Medical Research Council of Australia (NHMRC) and National Heart Foundation (NHF) postgraduate scholarships. EN is supported by an NHMRC postgraduate scholarship. JB is supported by NHMRC and NHF postgraduate scholarships. ZN is supported by NHMRC and NHF fellowships. DS is supported by NHF grants. AJT is supported by an NHMRC investigator grant. The study was supported by Ambulance Victoria and the Department of Cardiology, Alfred Health.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.