RT Journal Article SR Electronic T1 Healthcare cost burden of acute chest pain presentations JF Emergency Medicine Journal JO Emerg Med J FD BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine SP emermed-2022-212674 DO 10.1136/emermed-2022-212674 A1 Luke Dawson A1 Emily Nehme A1 Ziad Nehme A1 Ella Zomer A1 Jason Bloom A1 Shelley Cox A1 David Anderson A1 Michael Stephenson A1 Jeffrey Lefkovits A1 Andrew Taylor A1 David Kaye A1 Louise Cullen A1 Karen Smith A1 Dion Stub YR 2023 UL http://emj.bmj.com/content/early/2023/03/14/emermed-2022-212674.abstract AB 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.Data are available upon reasonable request. The data underlying this article will be shared on reasonable request to the corresponding author.