Short term cost effectiveness of a regional myocardial infarction network

Ralf Birkemeyer,Werner Jung,Anke Dauch,Henrik Schneider,Steffen Wahler,Hueseyin Ince,Manfred Beck,Alfred Müller

doi:10.1186/2191-1991-3-10

Abstract

AimsMyocardial infarction networks have been shown to improve guideline adherent therapy and outcomes in patients presenting with acute ST-elevation myocardial infarction (STEMI). Our objective was to assess the short term cost effectiveness of a network structure.Methods and resultsOutcome data and reimbursement data for the index hospital stay were gathered in consecutive patients with acute STEMI (n = 536) admitted to any of the hospitals in a 350.000 inhabitant rural network area during the years 2002 (n = 185), 2005 (n = 163) and 2008 (n = 188). Network structure was established between 2002 and 2005 aiming for identical treatment of all acute STEMI patients during 24 h/7d a week with primary angioplasty. Patient baseline characteristics in the different years were quite comparable. From 2002 to 2005 regional hospital mortality in STEMI patients decreased from 16% to 9%. Lower mortality under network conditions was confirmed in 2008. Reimbursement data of different years were standardized to exclude effects not induced by the network. The mean initial costs per saved live during the index stay were €7727 with a 95%-confidence interval of €-3.500 to €36.700 (referenced to the German reimbursement in 2005).ConclusionThe short term cost effectiveness of a myocardial infarction network organisation is within well accepted boundaries under conditions of the German reimbursement system.

Highlights

After a steep increase in infarction mortality in the nineteen-fifties and nineteen-sixties myocardial infarction became the most frequent cause of death world wide
Reperfusion is especially demanded for STelevation myocardial infarction (STEMI) which is an entity of myocardial infarctions that can be readily identified by well-defined criteria in the rest electrocardiogram
The uniform, regional primary percutaneous coronary intervention (PCI) protocol aims for identical treatment of all acute ST-elevation myocardial infarction (STEMI) patients during 24 h/7d a week in one interventional centre

Summary

Introduction

After a steep increase in infarction mortality in the nineteen-fifties and nineteen-sixties myocardial infarction became the most frequent cause of death world wide. Since the nineteen-nineties infarction mortality is on the decline again. This was induced by behavioural changes with respect to modifiable risk factors and a better acute and chronic therapy for patients presenting with acute myocardial infarction. Reperfusion is especially demanded for STelevation myocardial infarction (STEMI) which is an entity of myocardial infarctions that can be readily identified by well-defined criteria in the rest electrocardiogram (ECG) and clinical symptoms. There are only a few conditions which mimic the ECG changes and symptoms of a STEMI. These so called masquerading STEMI’s usually represent less than 5% of the initially diagnosed STEMI patients [1]

Methods

Results

Conclusion