Transportation to PCI-capable hospitals most cost-effective strategy for STEMI treatment
MedWire News: Transporting all patients with suspected ST-segment-elevation myocardial infarction (STEMI) straight to existing percutaneous coronary intervention (PCI) centers would be less costly and more effective than various hospital expansion options, say US researchers.
"Expanding patient access to PCI is critical to improving outcomes after heart attack and there are a range of approaches to accomplish this," said lead study author Thomas Concannon from Tufts Medical Center in Boston, Massachusetts.
"Our study is the first to compare an EMS strategy of ambulance diversion to a number of hospital-based PCI expansion strategies," he said.
As reported in the journal Circulation: Cardiovascular Quality and Outcomes, the authors estimated incremental treatment costs and quality-adjusted life expectancies of 2000 patients with STEMI in Dallas County, Texas.
They used computer models to compare a base case strategy with no new construction or staffing, one where patients are transported by EMS directly to a PCI enabled facility, and 13 others combining various laboratory construction and increased staffing expansion plans.
The team found that the ambulance diversion strategy was more than twice as effective as any of the 13 increased construction or staffing plans, and 20 times less expensive.
In total, it saved 2749.8 quality-adjusted life years (QALYs) at a cost of US $506.0 (€387.3) per QALY, saving significantly more QALYs at a significantly lower cost per QALY than the other 13 strategies.
"Cost-wise, we looked at this from a societal perspective - the amount of money being spent on this care, regardless of who spends it," said Concannon. "The study suggests it would cost significantly more money to build and staff new PCI capacity than it would to divert to currently operating PCI labs."
The researchers conclude: "Our results suggest that regional planners should consider EMS strategies for increasing access to PCI before adopting strategies involving new construction or increased staffing of PCI hospitals."
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By Helen Albert