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Updated: Aug 7, 2026
Primary Outcome Assessment in a Pig Model of Acute Myocardial Infarction
Published on: October 14, 2016
Projected cost-effectiveness of primary angioplasty for acute myocardial infarction
T A Lieu1, R J Gurley, R J Lundstrom
1Division of Research, The Permanente Medical Group, Oakland, California 94611, USA. tal@dor.kaiser.org
Insights
Primary angioplasty for acute myocardial infarction is cost-effective at hospitals with existing cardiac labs, especially with high patient volumes. Low volumes or redundant labs increase costs, suggesting regionalization of cardiac services.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Health Services Research
Background:
- Primary angioplasty shows reduced mortality for acute myocardial infarction (AMI).
- AMI treatment effectiveness varies, and most US hospitals lack cardiac catheterization labs.
- Cost-effectiveness data is crucial for adopting primary angioplasty.
Purpose of the Study:
- To evaluate the cost-effectiveness of primary angioplasty for AMI.
- To analyze cost-effectiveness under varying assumptions of effectiveness, facilities, staffing, and patient volume.
- To inform decisions regarding the adoption of primary angioplasty.
Main Methods:
- A decision analytic model compared primary angioplasty, thrombolysis, and no intervention.
- Health outcome probabilities derived from randomized trials and community studies.
- Scenarios included existing labs, new labs (needed or redundant), and varying annual AMI patient volumes (200, <150).
Main Results:
- Primary angioplasty was cost-saving versus thrombolysis and cost $12,000/QALY saved versus no intervention (base case).
- At hospitals with existing labs and ≥200 AMI patients annually, cost was <$30,000/QALY saved.
- Cost-effectiveness decreased significantly at low volumes (<150 AMI patients) or with redundant labs.
Conclusions:
- Primary angioplasty is cost-effective at hospitals with existing cardiac catheterization labs and sufficient patient volume.
- Cost-ineffectiveness at low volumes or redundant labs supports regionalizing cardiac services.
- Overcoming competitive barriers and monitoring outcomes/costs are essential for successful implementation.
Objectives:
This study sought to evaluate the cost-effectiveness of primary angioplasty for acute myocardial infarction under varying assumptions about effectiveness, existing facilities and staffing and volume of services.
Background:
Primary angioplasty for acute myocardial infarction has reduced mortality in some studies, but its actual effectiveness may vary, and most U.S. hospitals do not have cardiac catheterization laboratories. Projections of cost-effectiveness in various settings are needed for decisions about adoption.
Methods:
We created a decision analytic model to compare three policies: primary angioplasty, intravenous thrombolysis and no intervention. Probabilities of health outcomes were taken from randomized trials (base case efficacy assumptions) and community-based studies (effectiveness assumptions). The base case analysis assumed that a hospital with an existing laboratory with night/weekend staffing coverage admitted 200 patients with a myocardial infarction annually. In alternative scenarios, a new laboratory was built, and its capacity for elective procedures was either 1) needed or 2) redundant with existing laboratories.
Results:
Under base case efficacy assumptions, primary angioplasty resulted in cost savings compared with thrombolysis and had a cost of $12,000/quality-adjusted life-year (QALY) saved compared with no intervention. In sensitivity analyses, when there was an existing cardiac catheterization laboratory at a hospital with > or = 200 patients with a myocardial infarction annually, primary angioplasty had a cost of < $30,000/QALY saved under a wide range of assumptions. However, the cost/QALY saved increased sharply under effectiveness assumptions when the hospital had < 150 patients with a myocardial infarction annually or when a redundant laboratory was built.
Conclusions:
At hospitals with an existing cardiac catheterization laboratory, primary angioplasty for acute myocardial infarction would be cost-effective relative to other medical interventions under a wide range of assumptions. The procedure's relative cost-ineffectiveness at low volumes or redundant laboratories supports regionalization of cardiac services in urban areas. However, approaches to overcoming competitive barriers and close monitoring of outcomes and costs will be needed.
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