Comparative effectiveness of ST-segment-elevation ... [Circ Cardiovasc Qual Outcomes. 2010] - PubMed result

Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):506-13. Epub 2010 Jul 27.

Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies.
Concannon TW, Kent DM, Normand SL, Newhouse JP, Griffith JL, Cohen J, Beshansky JR, Wong JB, Aversano T, Selker HP.

Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA. tconcannon@tuftsmedicalcenter.org


Comment in:

Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):441-3.

Abstract
BACKGROUND: Primary percutaneous coronary intervention (PCI) is more effective on average than fibrinolytic therapy in the treatment of ST-segment-elevation myocardial infarction. Yet, most US hospitals are not equipped for PCI, and fibrinolytic therapy is still widely used. This study evaluated the comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies to increase the use of PCI against standard emergency transport and care.

METHODS AND RESULTS: We estimated incremental treatment costs and quality-adjusted life expectancies of 2000 patients with ST-segment-elevation myocardial infarction who received PCI or fibrinolytic therapy in simulations of emergency care in a regional hospital system. To increase access to PCI across the system, we compared a base case strategy with 12 hospital-based strategies of building new PCI laboratories or extending the hours of existing laboratories and 1 emergency medical services-based strategy of transporting all patients with ST-segment-elevation myocardial infarction to existing PCI-capable hospitals. The base case resulted in 609 (95% CI, 569-647) patients getting PCI. Hospital-based strategies increased the number of patients receiving PCI, the costs of care, and quality-adjusted life years saved and were cost-effective under a variety of conditions. An emergency medical services-based strategy of transporting every patient to an existing PCI facility was less costly and more effective than all hospital expansion options.

CONCLUSION: Our results suggest that new construction and staffing of PCI laboratories may not be warranted if an emergency medical services strategy is both available and feasible.

PMID: 20664025 [PubMed - in process]PMCID: PMC2967250
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Comparative Effectiveness of STEMI Regionalization Strategies


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Comparative Effectiveness of ST-Segment–Elevation Myocardial Infarction Regionalization Strategies — Circulation: Cardiovascular Quality and Outcomes


Figure 1STEMI Regionalization Strategies - Cost per Quality Adjusted Life YearQuality-adjusted life years saved are presented on the x-axis and cost in 2008 dollars on the y-axis. The base strategy is positioned at (0,0). Hospital strategies (B-N) are depicted with a diamond. The EMS strategy (O) is depicted with a square.Comparative Effectiveness of STEMI Regionalization StrategiesCirc Cardiovasc Qual Outcomes. Author manuscript; available in PMC 2010 November 1.;3(5):506-513.
Comparative effectiveness of ST-segment-elevation ... [Circ Cardiovasc Qual Outcomes. 2010] - PubMed result