Cost-Effectiveness of Supersaturated Oxygen Delivery for Infarct Size Reduction in Patients With Anterior ST-Segment...

Myocardial infarct size (IS) is a key determinant of long-term outcomes after acute myocardial infarction (MI). Although infusion of supersaturated oxygen (SSO₂) after primary percutaneous coronary intervention (PPCI) has been shown to reduce IS among patients with acute anterior ST-segment elevation myocardial infarction (STEMI), the cost-effectiveness of this approach remains unknown.

We developed a Markov model to project long-term mortality, quality of life, and costs among patients with acute anterior STEMI undergoing PPCI. Among surviving patients, we modeled the incidence of post-MI heart failure, cardiovascular death, and noncardiovascular death as a function of IS, using population-based data for calibration. Health state-specific costs were derived from Medicare data. The cost of SSO₂ (including supplies, procedure time, and physician costs) was assumed to be $10,528. Deterministic and probabilistic sensitivity analyses were used to quantify the effects of uncertainty on the results.

In our base case analysis (mean age 61 years; 22% female; mean IS 25% of LV mass), treatment with SSO₂ was projected to increase discounted life expectancy (14.21 vs 14.12 years) and quality-adjusted life expectancy (10.78 vs 10.69 quality-adjusted life-years [QALYs]) while increasing lifetime costs by $3205/patient. The incremental cost-effectiveness ratio for SSO₂ vs standard care was $38,415/QALYs gained, which was sensitive to patient age, IS with standard care, and the impact of SSO₂ on IS. For this population, the probability that SSO₂ provides good economic value (at a societal willingness-to-pay threshold of $120,000/QALYs) was 73%.

Based on our disease simulation model, SSO₂ therapy for patients undergoing PPCI for acute anterior STEMI appears to be a cost-effective adjunct to PPCI from the perspective of the US health care system.