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Published on: November 26, 2013
Cost-effectiveness of primary percutaneous coronary intervention versus thrombolytic therapy for acute myocardial
Randi Selmer1, Sigrun Halvorsen, Kurt I Myhre
1Norwegian Institute of Public Health, Oslo, Norway. Randi.Selmer@fhi.no
Insights
Primary percutaneous coronary intervention (PCI) offers better long-term health outcomes and lower costs compared to thrombolytic therapy for ST-segment elevation myocardial infarction (STEMI) patients.
Area of Science:
- Cardiology
- Health Economics
- Interventional Cardiology
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) requires prompt reperfusion.
- Primary percutaneous coronary intervention (PCI) and thrombolytic therapy are key reperfusion strategies.
- Evaluating the long-term cost-effectiveness of these modalities is crucial for healthcare resource allocation.
Purpose of the Study:
- To compare the long-term cost-effectiveness of primary PCI versus thrombolytic therapy in STEMI patients.
- To assess the impact of reperfusion strategy on life expectancy and lifetime costs.
- To inform clinical decision-making in a cost-conscious healthcare environment.
Main Methods:
- A state-transition model was developed to simulate patient pathways from STEMI onset to death.
- The model incorporated key events and health states relevant to STEMI management.
- Sensitivity analyses were performed to test the robustness of the findings.
Main Results:
- Primary PCI was associated with increased life expectancy (8.3 years) compared to thrombolytic therapy (7.6 years) for a 65-year-old man.
- Lifetime costs were lower with primary PCI (€19,250) versus thrombolytic therapy (€29,250) for patients near invasive centers.
- Cost savings with PCI were primarily driven by reduced future interventions; helicopter transport costs impacted overall figures.
Conclusions:
- Primary PCI provides superior health benefits and reduced lifetime costs compared to thrombolytic therapy for STEMI.
- These findings support the adoption of primary PCI, particularly in resource-constrained healthcare settings.
- The study highlights the economic advantages of timely reperfusion with primary PCI.
Objectives:
We sought to determine the long-term cost-effectiveness of two reperfusion modalities in patients with acute ST-segment elevation myocardial infarction: primary percutaneous coronary intervention (PCI) versus thrombolytic therapy.
Design:
A state-transition model that follows patients from when they develop STEMI until they die was developed. The model encompassed events and health states. Sensitivity analyses were undertaken.
Results:
For a 65-year old man, life expectancy was 8.3 years with primary PCI and 7.6 years with thrombolytic therapy. The lifetime costs were 19,250 euros (NOK 154,000) and 29,250 euros (NOK 234,000), respectively, for patients living close to an invasive unit. Cost savings from PCI were mainly due to the reduction in future coronary interventions. For patients needing helicopter transport to arrive in time to an invasive unit for PCI, the costs were 24,000 euros (NOK 192,000) and 29,250 euros (NOK 234,000), respectively (all costs undiscounted). For women, the estimates were somewhat higher due to lower mortality.
Conclusion:
Compared with thrombolytic therapy, reperfusion by primary PCI results in greater health benefits at reduced lifetime costs. These findings may have important clinical implications in an increasing cost-conscious health care environment.
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