Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies

Thomas W. Concannon, David M. Kent, Sharon Lise Normand, Joseph P. Newhouse, John L. Griffith, Joshua Cohen, Joni R. Beshansky, John B. Wong, Thomas R Aversano, Harry P. Selker

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)506-513
Number of pages8
JournalCirculation: Cardiovascular Quality and Outcomes
Volume3
Issue number5
DOIs
StatePublished - Sep 2010

Fingerprint

Percutaneous Coronary Intervention
Emergency Medical Services
Thrombolytic Therapy
ST Elevation Myocardial Infarction
Costs and Cost Analysis
Quality-Adjusted Life Years
Life Expectancy
Health Care Costs
Quality of Life

Keywords

  • Cost-benefit analysis
  • Fibrinolysis
  • Percutaneous coronary intervention
  • ST-segment-elevation myocardial infarction
  • Thrombolysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Concannon, T. W., Kent, D. M., Normand, S. L., Newhouse, J. P., Griffith, J. L., Cohen, J., ... Selker, H. P. (2010). Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies. Circulation: Cardiovascular Quality and Outcomes, 3(5), 506-513. https://doi.org/10.1161/CIRCOUTCOMES.109.908541

Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies. / Concannon, Thomas W.; Kent, David M.; Normand, Sharon Lise; Newhouse, Joseph P.; Griffith, John L.; Cohen, Joshua; Beshansky, Joni R.; Wong, John B.; Aversano, Thomas R; Selker, Harry P.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 3, No. 5, 09.2010, p. 506-513.

Research output: Contribution to journalArticle

Concannon, TW, Kent, DM, Normand, SL, Newhouse, JP, Griffith, JL, Cohen, J, Beshansky, JR, Wong, JB, Aversano, TR & Selker, HP 2010, 'Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies', Circulation: Cardiovascular Quality and Outcomes, vol. 3, no. 5, pp. 506-513. https://doi.org/10.1161/CIRCOUTCOMES.109.908541
Concannon, Thomas W. ; Kent, David M. ; Normand, Sharon Lise ; Newhouse, Joseph P. ; Griffith, John L. ; Cohen, Joshua ; Beshansky, Joni R. ; Wong, John B. ; Aversano, Thomas R ; Selker, Harry P. / Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies. In: Circulation: Cardiovascular Quality and Outcomes. 2010 ; Vol. 3, No. 5. pp. 506-513.
@article{570039fe3a9342efa34366a9848841c6,
title = "Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies",
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.",
keywords = "Cost-benefit analysis, Fibrinolysis, Percutaneous coronary intervention, ST-segment-elevation myocardial infarction, Thrombolysis",
author = "Concannon, {Thomas W.} and Kent, {David M.} and Normand, {Sharon Lise} and Newhouse, {Joseph P.} and Griffith, {John L.} and Joshua Cohen and Beshansky, {Joni R.} and Wong, {John B.} and Aversano, {Thomas R} and Selker, {Harry P.}",
year = "2010",
month = "9",
doi = "10.1161/CIRCOUTCOMES.109.908541",
language = "English (US)",
volume = "3",
pages = "506--513",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Comparative effectiveness of ST-segment-elevation myocardial infarction regionalization strategies

AU - Concannon, Thomas W.

AU - Kent, David M.

AU - Normand, Sharon Lise

AU - Newhouse, Joseph P.

AU - Griffith, John L.

AU - Cohen, Joshua

AU - Beshansky, Joni R.

AU - Wong, John B.

AU - Aversano, Thomas R

AU - Selker, Harry P.

PY - 2010/9

Y1 - 2010/9

N2 - 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.

AB - 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.

KW - Cost-benefit analysis

KW - Fibrinolysis

KW - Percutaneous coronary intervention

KW - ST-segment-elevation myocardial infarction

KW - Thrombolysis

UR - http://www.scopus.com/inward/record.url?scp=78650211376&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=78650211376&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.109.908541

DO - 10.1161/CIRCOUTCOMES.109.908541

M3 - Article

C2 - 20664025

AN - SCOPUS:78650211376

VL - 3

SP - 506

EP - 513

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 5

ER -