Systematic investment in the delivery of guideline-coherent therapy reduces mortality and overall costs in patients with ST-elevation myocardial infarction: Results from the Stent for Life economic model for Romania, Portugal, Basque Country and Kemerovo region

Abstract

Aims: The Stent for Life initiative aims at the reduction of mortality in patients with ST-elevation myocardial infarction by enhancing timely access to primary percutaneous coronary intervention. To assess the associated health and socioeconomic impact, the Stent for Life economic project was launched and applied to four model regions: Romania, Portugal, the Basque Country in Spain, and the Kemerovo region in the Russian Federation.

Methods and results: The Stent for Life economic model is based on a decision tree that incorporates primary percutaneous coronary intervention rates and mortality. Healthcare costs and indirect costs caused by loss of productivity were estimated. A baseline scenario simulating the status quo was compared to the Stent for Life scenario which integrated changes initiated by the Stent for Life programme. In the four model regions, primary percutaneous coronary intervention numbers rose substantially between 29-303%, while ST-elevation myocardial infarction mortality was reduced between 3-10%. Healthcare costs increased by 8% to 70%. Indirect cost savings ranged from 2-7%. Net societal costs were reduced in all model regions by 2-4%.

Conclusion: The joint effort of the Stent for Life initiative and their local partners successfully saves lives. Moreover, the increase in healthcare costs was outweighed by indirect cost savings, leading to a net cost reduction in all four model regions. These findings demonstrate that systematic investments to improve the access of ST-elevation myocardial infarction patients to guideline-coherent therapy is beneficial, not only for the individual, but also for the society at large.

Keywords: ST-elevation myocardial infarction; Stent for Life; Stent – Save a Life; costs; net benefit; primary percutaneous intervention; savings.

Figure 1.

Decision tree model to quantify the impact of the Stent for Life (SFL) initiative. CABG: coronary artery bypass graft; PCI: percutaneous coronary intervention; STEMI: ST-elevation myocardial infarction.

Figure 2.

Numbers of primary percutaneous coronary intervention (PCIs) per million population at the start and after the program of the Stent for Life (SFL) initiative and their relative change. Pre-SFL: at the start of the SFL initiative; Post-SFL: after the SFL initiative.

Figure 3.

Incremental direct, indirect, annual, and cumulated net costs of the Stent for Life scenario compared to the baseline-scenario, as well as the incremental cumulated number of lives saved for (a) Romania, (b) Portugal, (c) Basque Country, Spain and (d) the Kemerovo region, Russian Federation, respectively. Costs are displayed in millions of US dollars; positive costs stand for additional spending, negative ones for savings; net costs are the difference between direct and indirect costs per annum and cumulated, respectively; direct costs include variable and fixed costs (e.g. investments) – Portugal and the Basque Country were without substantial fixed costs; Lives saved are the cumulated incremental numbers of lives saved in the Stent for Life scenario compared to the baseline scenario.