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Multicenter Study
. 2015 Dec 9;5(12):e009148.
doi: 10.1136/bmjopen-2015-009148.

Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network

Ander Regueiro  1 , Julia Bosch  2 , Victoria Martín-Yuste  3 , Alba Rosas  4 , Maria Teresa Faixedas  4 , Joan Antoni Gómez-Hospital  5 , Jaume Figueras  6 , Antoni Curós  7 , Angel Cequier  5 , Javier Goicolea  8 , Antonio Fernández-Ortiz  8 , Carlos Macaya  8 , Ricard Tresserras  4 , Laura Pellisé  2 , Manel Sabaté  1
Affiliations
Multicenter Study

Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network

Ander Regueiro et al. BMJ Open. .

Abstract

Objectives: To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart).

Design: Cost-utility analysis.

Setting: The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people.

Participants: Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries.

Outcome measures: Costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140).

Results: A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30,000, results were sensitive to variations in costs and outcomes.

Conclusions: The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.

Keywords: HEALTH ECONOMICS.

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Figures

Figure 1
Figure 1
Catalonian acute coronary syndrome registries used to extract outcome of patients with STEMI (30-day mortality) before and after the network implementation (STEMI, ST-segment elevation myocardial infarction).
Figure 2
Figure 2
Reperfusion strategy distribution after the implementation of the STEMI network, showing a significant decrease in the proportion of patients treated with rescue PCI, fibrinolysis or non-reperfused and a significant increase in the proportion of patients treated with primary PCI (PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction).
Figure 3
Figure 3
Sensitivity analysis. ICER modifications as a result of a sensitivity analysis with the scenario of performing coronary angiography within the next 24 h after fibrinolysis (ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year).
See this image and copyright information in PMC

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