Cost-effectiveness of a European ST-segment elevation myocardial infarction network : results from the Catalan Codi Infart network
Regueiro, Ander (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Bosch, Julia (Universitat Pompeu Fabra)
Martín-Yuste, Victoria (Institut d'Investigacions Biomèdiques August Pi i Sunyer)
Rosas, Alba (Generalitat de Catalunya)
Faixedas, Maria Teresa (Generalitat de Catalunya)
Gómez-Hospital, Joan Antoni (Hospital Universitari de Bellvitge)
Figueras Bellot, Jaume (Hospital Universitari Vall d'Hebron)
Curós, Antoni (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Cequier, Ángel (Hospital Universitari de Bellvitge)
Goicolea, Javier (Iniciativa Stent for Life)
Fernández-Ortiz, Antonio (Iniciativa Stent for Life)
Macaya, Carlos (Iniciativa Stent for Life)
Tresserras, Ricard (Generalitat de Catalunya)
Pellisé, Laura (Universitat Pompeu Fabra)
Sabaté, Manel (Institut d'Investigacions Biomèdiques August Pi i Sunyer)

Fecha:	2015
Resumen:	To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart). Cost-utility analysis. The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7. 5 million people. Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries. Costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140). A substitution effect and a technology effect were observed; aggregate costs increased by 2. 6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7. 5% to 5. 6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30 000, results were sensitive to variations in costs and outcomes. The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	BMJ open, Vol. 5 (december 2015) , ISSN 2044-6055

DOI: 10.1136/bmjopen-2015-009148
PMID: 26656019

10 p, 1.2 MB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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