Abstract
Background: Currently, only 50% of ST-elevation myocardial infarction (STEMI) receive reperfusion therapy in China, and four standard oral medications-aspirin, beta blocker, statins, and angiotensin converting enzyme inhibitor-are utilized together in only 44-48% of hospitalized patients with acute myocardial infarction (AMI). This study was to simulate the effectiveness and costs of AMI treatment after improving utilization of selected standard AMI treatments in China by using the coronary heart disease(CHD) Policy Model-China. Methods: The CHD Policy Model-China is a computer-simulation, Markov model of cardiovascular disease which could simulate the incidence trend of AMI, cost and effectiveness of treatments. Current utilization of selected AMI interventions in China were obtained from the Bridging the Gap in Coronary Heart Disease Secondary Prevention in China Project. In eligible patients, 100% utilization was simulated for 1) four standard oral drugs for all AMI, 2) unfractionated heparin for non-ST-elevation myocardial infarction(NSTEMI), 3) reperfusion using percutaneous intervention(PCI) or thrombolysis for STEMI, and 4) early invasive PCI for NSTEMI. Results: The incremental cost-effectiveness ratio (ICER) of improving utilization of any of the selected acute in-hospital AMI treatments ranged from $2,977 to $24,558 per quality-adjusted life year (QALY) gained. Improving utilization of four standard oral medications in 100% of AMI patients by itself could save about 9,000 CHD deaths each year. Achieving 100% reperfusion in eligible STEMI patients with PCI would prevent the most CHD deaths (49,000 /year) and achieve the highest QALY increase (177,000/year). The ICER of achieving 100% reperfusion in eligible STEMI patients with PCI is 2.4 time higher than with thrombolysis, but could prevent 3 times CHD death than the latter. Only the ICER of PCI for NSTEMI was above the pre-determined cost effectiveness threshold for China ($7,974 per QALY gained). Conclusions: With the exception of PCI for NSTEMI, improved utilization of any of the acute in-hospital MI treatments was projected to be highly effective, and relatively low cost. Improving utilization of acute AMI treatments will be a useful strategy to prevent CHD deaths in China.
Published Version
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