Ta. Lieu et al., INITIAL COST OF PRIMARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION, Journal of the American College of Cardiology, 28(4), 1996, pp. 882-889
Objectives. We sought to evaluate the initial economic cost of primary
angioplasty for acute myocardial infarction under varying assumptions
about whether a cardiac catheterization laboratory exists, whether se
rvices are provided during night and weekend hours and how cardiovascu
lar surgical backup is arranged.Background. primary angioplasty for ac
ute myocardial infarction has resulted in clinical outcomes superior o
r equal to those obtained with thrombolysis in recent studies, but its
future implementation depends greatly on its cost and cost-effectiven
ess. There is a gap in knowledge about the true economic costs of this
procedure, and understanding costs under a variety of hypothetic scen
arios is important in planning whether and how the procedure should be
offered to broad groups of patients. Methods. A generalizable spreads
heet model was constructed to calculate the cost of primary angioplast
y at a single hospital with assumptions based on data from a large non
profit health maintenance organization (Kaiser Permanente). The follow
ing baseline assumptions were made: 1) A total of 200 patients with my
ocardial infarction presented to the hospital each year; 2) primary an
gioplasty was offered for 10 years; 3) the hospital had a cardiac cath
eterization laboratory; 4) costs of night call for technical personnel
and cardiovascular surgical backup were already covered, Other scenar
ios were modeled to represent different assumptions about existing res
ources. Results. Under the baseline assumptions, primary angioplasty c
ost $1,597/procedure. If night call for technical personnel were a new
expense, the average cost would be greater than or equal to$3,206. If
a new cardiac catheterization laboratory needed to be built, costs wo
uld range from $3,866 to $14,339/procedure, depending on how cardiovas
cular surgical backup was provided, Results vr ere sensitive to assump
tions about the annual volume of myocardial infarctions, the number of
years the procedure was offered and the costs of labor, construction
and equipment. Conclusions. The initial cost of providing primary angi
oplasty for acute myocardial infarction varies greatly, depending on t
he setting in which it is provided, To provide information for clinica
l policy decisions, a cost-effectiveness model is needed that combines
these initial costs with data on survival, quality of life and rates
and costs of subsequent cardiac procedures.