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GW24-e2168 Cost-effectiveness of Improving Acute Myocardial Infarction Treatments and the impact on mortality rate of coronary heart disease in China
  1. Wang Miao1,2,
  2. Andrew Moran3,4,
  3. Jing Liu1,2,
  4. Pamela Coxson5,
  5. Paul Heidenreich6,
  6. Dongfeng Gu7,8,
  7. Jiang He9,10,
  8. Lee Goldman4,
  9. Dong Zhao1,2
  1. 1Department of Epidemiology, Beijing an Zhen Hospital, Capital Medical University, Beijing, China
  2. 2Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
  3. 3Division of General Medicine, Columbia University Medical Center, New York, USA
  4. 4Columbia University College of Physicians and Surgeons, New York, USA
  5. 5University of California at San Francisco, San Francisco, USA
  6. 6Palo Alto VA Health Care System and Department of Medicine, Stanford University, Palo Alto, Calif, USA
  7. 7Department of Evidence Based Medicine, Cardiovascular Institute and Fu Wai Hospital of the Chinese Academy of Medical Sciences, Beijing, China
  8. 8National Center for Cardiovascular Diseases, Beijing, China
  9. 9Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
  10. 10Department of Medicine, Tulane University School of Medicine, New Orleans, USA

Abstract

Objectives To explore the cost-effectiveness of improving acute myocardial infarction (AMI) acute treatments and the potential impact on coronary heart disesease (CHD) mortality in China.

Methods The effectiveness and costs of improving utilisation of standard acute treatments in AMI patients were estimated by the CHD Policy Model-China. The number of 30 day deaths of AMI patients, CHD mortality, and quality-adjusted life year (QALY) were estimated as indicators of treatment effect. The incremental cost-effectiveness ratio (ICER) was used to evaluate the cost-effectiveness. The metric recommended by WHO CHOosing Interventions that are Cost Effective (WHO-CHOICE) was used to assess the degree of cost-effectiveness (highly cost-effective: ICER< gross domestic product (GDP) per capita, moderately cost-effective: ICER in 1–3 x GDP per capita, and not cost-effective: ICER >3 x GDP per capita).

Results The results showed that improving utilisation of the four drugs (aspirin, β blockers, statins and angiotensin-converting enzyme inhibitors) for all eligible AMI patients and improving utilisation of unfractionated heparin in patients with non-ST elevation myocardial infarction (NSTEMI) were highly cost-effective strategies. Improving PCI use in all eligible patients with ST elevation myocardial infarction (STEMI), or improving PCI use in tertiary hospitals but thrombolysis use of secondary hospital in STEMI patients were also cost-effective strategies. Even recommended by the guidelines, improving utilisation of clopidogrel for all eligible AMI and improving PCI use in high risk NSTEMI in tertiary hospitals were not cost-effective strategies. By the comparative effectiveness, improving PCI use in STEMI patients was the most effective strategy, which could prevent 53,596 AMI deaths. If all the treatment strategies were fully improved, 71,730 AMI deaths could be prevented and lead to a maximum 10% decrease in CHD mortality rate.

Conclusions Most acute treatment strategies of AMI recommended by current guidelines are cost-effective strategies in China. Fully improving all acute treatment strategies for AMI have a limited effect on reduction of CHD mortality.

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