Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the CatalanCodi Infartnetwork

Abstract

ObjectivesTo evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart).DesignCost-utility analysis.SettingThe analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people.ParticipantsPatients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries.Outcome measuresCosts 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).ResultsA 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.ConclusionsThe Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

“…[64] CAC services could potentially overlap with the cardiovascular and neurologic services offered at regional STEMI and stroke centres. Whilst indirect evidence established the cost effectiveness of stroke and STEMI centres, [65,66] the cost effectiveness of specific strategies focusing on cardiac arrest patients and their potential impact on the care of other patient groups remains unknown.…”

Economic and Societal Impact of a Systems-of-Care Approach for STEMI Management in Low and Middle-Income Countries: Insights from the TN STEMI Program

“…For instance, the ICER of utilizing primary PCI for all-comers with STEMI in China was estimated at USD 10,700 [22]. Similarly, the Catalan STEMI study from Spain estimated the ICER of implementing a STEMI-network to be Euro 4,355 (USD 5,383) [23]. We also only considered mortality, but further benefits can be expected from reductions in morbidity as well.…”

[camara] Encuesta sobre las necesidades de los programas de angioplastia primaria en Espa�a

“…En este sentido, la monitorización y la medición de datos continua en cada comunidad debería incluir, además de los datos asistenciales y médicos, las necesidades de los profesionales involucrados en el proceso asistencial dentro de los puntos de mejora. Las Administraciones competentes deberían velar por asegurar la sostenibilidad de los programas de ICPp, que en nuestro país se han mostrado claramente coste-eficaces 11 , aportando las inversiones necesarias.…”

“…La edad de los encuestados fue de 45 ± 8 años (rango 28-66 años), [39-50 años]. Los años de experiencia realizando angioplastia primaria fueron 9,5 ± 5,7 (rango 0-21),[5][6][7][8][9][10][11][12][13].En el anexo 1 se detallan los centros públicos participantes por comunidades autónomas.Características de los programas de ICPpEn cuanto a la actividad asistencial en el IAMCEST, el número de procedimientos anuales de ICPp que se realizaron por centro (tomando los datos proporcionados por los propios centros al Registro de la SHCI de 2017 7 ) fueron 239 ± 112 (rango 14-587), mientras que el número de angioplastias en IAMCEST por centro (angioplastia primaria, angioplastia de rescate y angioplastia precoz tras trombólisis efectiva) fue de 259 ± 110 (rango 15-596) por año.…”