INITIAL COST OF PRIMARY ANGIOPLASTY FOR ACUTE MYOCARDIAL-INFARCTION

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.