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Introduction Updated conveyance algorithms prioritizing direct transport of out-of-hospital cardiac arrest (OHCA) patients to Cardiac Arrest Centres (CACs) have shown promise in observational studies, particularly for those presenting with an initial shockable rhythm. An observational pilot by Simpson et al. (2025) on the implementation of the British Cardiovascular Intervention Society (BCIS) OHCA conveyance algorithm demonstrated reduced mortality in patients transported directly to a CAC with an initial shockable rhythm. Centralizing post-arrest care at CACs may improve survival through specialized multidisciplinary treatment tailored to case complexity. However, further research is needed to refine patient selection and optimize outcomes.Purpose This study evaluates the economic impact and cost-effectiveness of implementing the BCIS OHCA conveyance algorithm within Essex, UK, to inform national health policymakers on optimizing patient outcomes and resource allocation.Methods A hybrid decision tree and Markov model were developed to assess the cost-effectiveness of the BCIS conveyance algorithm compared to standard care (SoC – no conveyance algorithm to a CAC) over a lifetime horizon. The model used a hypothetical cohort of 9,000 patients (mean age 65 years), with inputs derived from an observational BCIS pilot study covering a 2.3 million population and consecutive cases from the BCIS OHCA registry (April 2022–March 2023), supplemented by relevant literature. Cost-effectiveness was evaluated using incremental cost per life-year gained and incremental cost per quality-adjusted life year (QALY) gained.Results The BCIS algorithm was more effective than SoC, reducing intensive care unit (ICU), ward, post-assessment, and ambulance-related costs. Over a lifetime horizon, it yielded 0.43 additional QALYs at an incremental cost of £1,244 per patient, resulting in an incremental cost-effectiveness ratio (ICER) of £2,926 per QALY gained—well within the £30,000 willingness-to-pay (WTP) threshold set by the National Institute for Health and Care Excellence (NICE). Probabilistic sensitivity analysis (PSA) indicated an 86.3% probability of cost-effectiveness at this WTP threshold and a 33.7% probability of being cost saving.Abstract 2-036 Figure 1Cost-effectiveness planeAbstract 2-036 Figure 2Cost-effectiveness acceptability curveConclusion Implementing the BCIS OHCA conveyance algorithm is a cost-effective strategy, enhancing survival, QALYs, and resource efficiency compared to SoC. Centralizing shockable rhythm post-arrest care at CACs improves neurological outcomes, a key driver of cost-effectiveness. While increased admissions and neuroprognostication costs are observed, these are offset by reductions in ICU, ward, post-assessment, and ambulance-related expenses. These findings support targeted investment in CAC-focused care for OHCA with a shockable rhythm or STEMI to improve both clinical and economic outcomes.