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Optimal acute MI treatment may be cost-effective, reduce mortality in China
In China, optimal use of most standard in-hospital treatments for acute MI, particularly in combination, would be cost-effective and modestly reduce mortality, according to recent study findings.
This benefit, however, may be limited by the number of acute MI deaths that occur outside of the hospital, the study researchers also found.
The researchers utilized the CHD Policy Model-China, a computer-simulated Markov model of CHD, to approximate the effectiveness and costs of the best use of hospital-based acute MI treatment.
The following hospital-based treatment protocols for STEMI and non-STEMI, as advocated by Chinese and international guidelines, were included: optimal use of aspirin, beta-blockers, statins and ACE inhibitors within 30 days of MI onset; optimized use of clopidogrel within 30 days of onset; ideal use of unfractionated heparin in patients with non-STEMI; ideal use of primary PCI in tertiary hospitals, and thrombolysis in secondary hospitals, among patients with STEMI; optimal use of primary PCI in all patients with STEMI, and best use of primary PCI in high-risk non-STEMI patients in tertiary facilities.
The investigators calculated increased costs incurred through the optimized use of these therapies by multiplying the number of additional patients resulting from optimized use by the mean treatment cost. Quality-adjusted life years gained, 30-day in-hospital acute MI deaths avoided and overall change in CHD mortality were used to approximate the effectiveness of the optimized treatment protocols.
The optimized administration of four oral drugs (aspirin, beta-blockers, statins and ACE inhibitors) in all appropriate patients with acute MI, or unfractionated heparin in non-STEMI patients, was highly cost-effective, with incremental cost-effectiveness ratios of approximately $3,100 or less. Moderate cost-effectiveness was projected with the optimized use of reperfusion treatment in appropriate candidates with STEMI (incremental cost-effectiveness ratio of $10,700 or less). Only modest cost-effectiveness was determined for the optimal use of clopidogrel in appropriate cases of acute MI, as well as primary PCI in high-risk non-STEMI patients in tertiary hospitals alone. The combined use of all of the optimized hospital-based acute MI treatments was found to be cost-effective and projected to reduce the total CHD-related mortality rate in China by 9.6% at most.
“Because so many [acute] MI deaths occur outside of the hospital in China, full and simultaneous improvements of all standard hospital-based [acute] MI treatment strategies assessed in this study would decrease CHD mortality by <10%,” the researchers wrote. “Improvement of the capacity of prehospital care for patients with [acute] MI is urgently needed in China.”
Disclosure: The researchers report no relevant financial disclosures.