Avoiding Routine Oxygen Therapy in Patients With Myocardial Infarction Saves Significant Expenditure for the Health Care System-Insights From the Randomized DETO2X-AMI Trial

Abstract

Background: Myocardial infarction (MI) occurs frequently and requires considerable health care resources. It is important to ensure that the treatments which are provided are both clinically effective and economically justifiable. Based on recent new evidence, routine oxygen therapy is no longer recommended in MI patients without hypoxemia. By using data from a nationwide randomized clinical trial, we estimated oxygen therapy related cost savings in this important clinical setting. Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction (DETO2X-AMI) trial randomized 6,629 patients from 35 hospitals across Sweden to oxygen at 6 L/min for 6-12 h or ambient air. Costs for drug and medical supplies, and labor were calculated per patient, for the whole study population, and for the total annual care episodes for MI in Sweden (N = 16,100) with 10 million inhabitants. Results: Per patient, costs were estimated to 36 USD, summing up to a total cost of 119,832 USD for the whole study population allocated to oxygen treatment. Applied to the annual care episodes for MI in Sweden, costs sum up to between 514,060 and 604,777 USD. In the trial, 62 (2%) patients assigned to oxygen and 254 (8%) patients assigned to ambient air developed hypoxemia. A threshold analysis suggested that up to a cut-off of 624 USD spent for hypoxemia treatment related costs per patient, avoiding routine oxygen therapy remains cost saving. Conclusions: Avoiding routine oxygen therapy in patients with suspected or confirmed MI without hypoxemia at baseline saves significant expenditure for the health care system both with regards to medical and human resources. Clinical Trial Registration: ClinicalTrials.gov, identifier: NCT01787110.

Keywords: health care costs and utilization; myocardial infarction; oxygen therapy; pragmatic clinical trial; randomized clinical trial (RCT); registries (MeSH).

Figure 1

Study flow chart. Eligible patients presenting to the ambulance service, emergency departments, or cardiology department (cath lab or cardiac care units) of participating hospitals with suspected myocardial infarction were evaluated for inclusion. Shown are the numbers of patients who were enrolled in the main study, randomly assigned to a study group (in black: total count; in red allocated to oxygen therapy; in blue allocated to ambient air), treated according to protocol or developed hypoxemia, and discharge diagnoses.

Figure 2

Threshold analysis of total direct cost by varying treatment costs for patients with suspected MI who develop hypoxemia.

Figure 3

Estimated total potential cost saving of oxygen therapy for patient with confirmed MI in Sweden annually, displayed by proportion of patients with oxygen saturation ≥ 90% at baseline.