Short term cost effectiveness of a regional myocardial infarction network
Ralf Birkemeyer1, Anke Dauch, Alfred Müller
1Heart Center Rostock, Universitätsklinikum Rostock, Ernst-Heydemann-Str, 6, 18057, Rostock, Germany. rbirkemeyer@t-online.de.
Insights
Implementing a myocardial infarction network improved patient outcomes and demonstrated short-term cost-effectiveness. This network structure is a viable option within the German healthcare system.
Area of Science:
- Cardiology
- Health Economics
Background:
- Myocardial infarction networks enhance guideline-adherent therapy and outcomes for ST-elevation myocardial infarction (STEMI) patients.
- Assessing the short-term economic impact of such network structures is crucial.
Purpose of the Study:
- To evaluate the short-term cost-effectiveness of a myocardial infarction network.
- To analyze the impact of a network structure on STEMI patient outcomes and costs.
Main Methods:
- Retrospective analysis of outcome and reimbursement data for 536 STEMI patients across three years (2002, 2005, 2008) in a rural network area.
- Standardization of reimbursement data to isolate network effects.
- Calculation of cost per life saved during the index hospital stay.
Main Results:
- Regional hospital mortality for STEMI patients decreased from 16% in 2002 to 9% by 2005, with sustained lower mortality in 2008.
- The mean initial cost per life saved during the index stay was €7727 (95% CI: €-3,500 to €36,700).
Conclusions:
- The myocardial infarction network organization demonstrates short-term cost-effectiveness.
- The economic viability is confirmed under the German reimbursement system.
Aims:
Myocardial infarction networks have been shown to improve guideline adherent therapy and outcomes in patients presenting with acute ST-elevation myocardial infarction (STEMI). Our objective was to assess the short term cost effectiveness of a network structure.
Methods And Results:
Outcome data and reimbursement data for the index hospital stay were gathered in consecutive patients with acute STEMI (n = 536) admitted to any of the hospitals in a 350.000 inhabitant rural network area during the years 2002 (n = 185), 2005 (n = 163) and 2008 (n = 188). Network structure was established between 2002 and 2005 aiming for identical treatment of all acute STEMI patients during 24 h/7d a week with primary angioplasty. Patient baseline characteristics in the different years were quite comparable. From 2002 to 2005 regional hospital mortality in STEMI patients decreased from 16% to 9%. Lower mortality under network conditions was confirmed in 2008. Reimbursement data of different years were standardized to exclude effects not induced by the network. The mean initial costs per saved live during the index stay were €7727 with a 95%-confidence interval of €-3.500 to €36.700 (referenced to the German reimbursement in 2005).
Conclusion:
The short term cost effectiveness of a myocardial infarction network organisation is within well accepted boundaries under conditions of the German reimbursement system.
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