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Initial cost of primary angioplasty for acute myocardial infarction
T A Lieu1, R J Lundstrom, G T Ray
1Division of Research, Permanente Medical Group, Inc., Oakland, California 94611, USA. tal@dor.kaiser.org
Insights
The initial cost of primary angioplasty for acute myocardial infarction varies significantly based on hospital resources and staffing. Understanding these economic factors is crucial for expanding access to this life-saving procedure.
Area of Science:
- Cardiovascular Medicine
- Health Economics
Background:
- Primary angioplasty offers superior or equal clinical outcomes to thrombolysis for acute myocardial infarction.
- The cost-effectiveness of primary angioplasty is critical for its widespread adoption.
- Knowledge gaps exist regarding the true economic costs of primary angioplasty.
Purpose of the Study:
- To evaluate the initial economic cost of primary angioplasty for acute myocardial infarction.
- To analyze cost variations based on the availability of cardiac catheterization laboratories and cardiovascular surgical backup.
- To assess the impact of providing services during night and weekend hours on procedure costs.
Main Methods:
- A generalizable spreadsheet model was developed to calculate primary angioplasty costs.
- Assumptions were based on data from a large nonprofit health maintenance organization.
- Scenarios modeled variations in existing resources, including laboratory availability and staffing.
Main Results:
- Under baseline assumptions (existing lab, covered backup), primary angioplasty cost $1,597 per procedure.
- Costs increased to over $3,206 if night call for technical personnel was a new expense.
- Building a new cardiac catheterization laboratory raised costs to $3,866-$14,339 per procedure.
Conclusions:
- The initial cost of primary angioplasty for acute myocardial infarction is highly dependent on the healthcare setting.
- A comprehensive cost-effectiveness model integrating initial costs with clinical outcomes is needed for policy decisions.
- Further analysis should include survival, quality of life, and subsequent cardiac procedure costs.
Objectives:
We sought to evaluate the initial economic cost of primary angioplasty for acute myocardial infarction under varying assumptions about whether a cardiac catheterization laboratory exists, whether services are provided during night and weekend hours and how cardiovascular surgical backup is arranged.
Background:
Primary angioplasty for acute myocardial infarction has resulted in clinical outcomes superior or equal to those obtained with thrombolysis in recent studies, but its future implementation depends greatly on its cost and cost-effectiveness. There is a gap in knowledge about the true economic costs of this procedure, and understanding costs under a variety of hypothetic scenarios is important in planning whether and how the procedure should be offered to broad groups of patients.
Methods:
A generalizable spreadsheet model was constructed to calculate the cost of primary angioplasty at a single hospital with assumptions based on data from a large nonprofit health maintenance organization (Kaiser Permanente). The following baseline assumptions were made: 1) A total of 200 patients with myocardial infarction presented to the hospital each year; 2) primary angioplasty was offered for 10 years; 3) the hospital had a cardiac catheterization laboratory; 4) costs of night call for technical personnel and cardiovascular surgical backup were already covered. Other scenarios were modeled to represent different assumptions about existing resources.
Results:
Under the baseline assumptions, primary angioplasty cost $1,597/procedure. If night call for technical personnel were a new expense, the average cost would be > or = $3,206. If a new cardiac catheterization laboratory needed to be built, costs would range from $3,866 to $14,339/procedure, depending on how cardiovascular surgical backup was provided. Results were sensitive to assumptions about the annual volume of myocardial infarctions, the number of years the procedure was offered and the costs of labor, construction and equipment.
Conclusions:
The initial cost of providing primary angioplasty for acute myocardial infarction varies greatly, depending on the setting in which it is provided. To provide information for clinical policy decisions, a cost-effectiveness model is needed that combines these initial costs with data on survival, quality of life and rates and costs of subsequent cardiac procedures.