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Economic evaluation of complete revascularization versus stress echocardiography-guided revascularization in the
Xacobe Flores-Ríos1, Ramón A Calviño-Santos2, Rodrigo Estévez-Loureiro3
1Unidad de Hemodinámica, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complejo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain.
Insights
Selective stress echocardiography-guided revascularization (SelR) is more cost-efficient than complete angiographic revascularization (ComR) for ST-elevation myocardial infarction patients with multivessel disease. Initial higher costs for ComR were not offset by follow-up savings.
Area of Science:
- Cardiology
- Health Economics
Background:
- Multivessel disease in ST-elevation acute myocardial infarction (STEMI) requires careful management decisions.
- Economic evaluations can inform optimal treatment strategies for STEMI patients.
Purpose of the Study:
- To conduct an economic evaluation of the Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction (CROSS-AMI) trial.
- To compare the cost-effectiveness of complete angiographic revascularization (ComR) versus selective stress echocardiography-guided revascularization (SelR) in STEMI patients.
Main Methods:
- A cost minimization analysis was performed on data from the CROSS-AMI randomized clinical trial (N=306).
- Costs included initial hospitalization and readmissions within the first year post-discharge.
- Health service utilization rates from the researchers' health system were applied.
Main Results:
- Index hospitalization costs were significantly higher in the ComR group (€19,657.9) compared to the SelR group (€14,038.7; P < .001).
- No significant differences in first-year follow-up rehospitalization costs were observed between the groups (ComR €2,423.5 vs. SelR €2,653.9; P = .697).
- Total costs over one year were substantially lower for SelR (€16,692.6) versus ComR (€22,081.3; P < .001).
Conclusions:
- The higher initial costs of ComR were not compensated by savings during the follow-up period.
- Selective stress echocardiography-guided revascularization (SelR) demonstrates greater economic efficiency than ComR for STEMI patients with multivessel disease undergoing emergent angioplasty.
- The findings support SelR as a more cost-effective strategy in this patient population.
Introduction And Objectives:
Economic studies may help decision making in the management of multivessel disease in the setting of myocardial infarction. We sought to perform an economic evaluation of CROSS-AMI (Complete Revascularization or Stress Echocardiography in Patients With Multivessel Disease and ST-Segment Elevation Acute Myocardial Infarction) randomized clinical trial.
Methods:
We performed a cost minimization analysis for the strategies (complete angiographic revascularization [ComR] and selective stress echocardiography-guided revascularization [SelR]) compared in the CROSS-AMI clinical trial (N=306), attributable the initial hospitalization and readmissions during the first year of follow-up, using current rates for health services provided by our health system.
Results:
The index hospitalization costs were higher in the ComR group than in SelR arm (19 657.9±6236.8 € vs 14 038.7±4958.5 €; P <.001). There were no differences in the costs of the first year of follow-up rehospitalizations between both groups for (ComR 2423.5±4568.0 vs SelR 2653.9±5709.1; P=.697). Total cost was 22 081.3±7505.6 for the ComR arm and 16 692.6±7669.9 for the SelR group (P <.001).
Conclusions:
In the CROSS-AMI trial, the initial extra economic costs of the ComR versus SelR were not offset by significant savings during follow-up. SelR seems to be more efficient than ComR in patients with ST-segment elevation acute coronary syndrome and multivessel disease treated by emergent angioplasty. Study registred at ClinicalTrial.gov (Identifier: NCT01179126).
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