. Author manuscript; available in PMC: 2014 Oct 9.

Published in final edited form as: Circ Cardiovasc Qual Outcomes. 2014 Jan 14;7(1):78–85. doi: 10.1161/CIRCOUTCOMES.113.000674

Table 1.

Main Assumptions for the Simulation of Optimal Use of Hospital-Based Acute Treatments for Patients With AMI in China

Treatments	Target Patients	Current Utilization, %	Effectiveness, Relative Risk (95% CI)	Costs in the Acute Stage, Average (Range)	Contraindications Rates, %	Rates of Adverse Events Attributable to the Treatment, %
Aspirin (75 mg daily, 30 d)	AMI	93.7^BRIG	0.77 (0.70–0.89)¹⁴	$0.04 ($0.039–$0.048)^*	0.7 (active bleeding)¹⁵	0.20 (intracranial hemorrhage^†)¹⁶
						0.30 (serious extracranial bleeding)¹⁷
β-Blockers (atenolol 50 mg daily, 30 d)	AMI	71.1^BRIG	0.88 (0.80–0.98)¹⁴	$0.49 ($0.44–$0.54)^*	22.3 (multiple^‡)^18–21	—
ACEIs (Captopril 50 mg daily, 30 d)	AMI	75.1^BRIG	0.94 (0.89–0.98)¹⁴	$1.09 ($0.98–$1.20)^*	0.7 (acute deterioration of glomerular filtration rate)²²	0.30 (angioedema)²²
					3.3 (hyperkalemia)²²
Statins (simvastatin 40 mg daily, 30 d)	AMI	74.1^BRIG	0.77 (0.58–1.01)²³	$27.93 ($25.14–$30.72)^*	1.0 (liver disease)^24,25	3.4×10⁻⁵ (rhabdomyolysis)²⁶
Statins (simvastatin 40 mg daily, 30 d)						1.0×10⁻⁵ (liver failure)²⁶
Clopidogrel (300 mg loading dose, 75 mg daily thereafter, 30 d)	AMI	49.4^BRIG	0.93 (0.87–0.99)¹⁶	$103.50 ($93.15–$113.85)^*	0.7 (active bleeding)¹⁵	0.58 (cerebral and major noncerebral bleeding)¹⁶
					1.6 (clopidogrel hypersensitivity)²⁷	0.58 (cerebral and major noncerebral bleeding)¹⁶
Intravenous unfractionated heparin (1200 U hourly, 70-kg patient, 3 d)	NSTEMI	78.8^BRIG	0.84 (0.36–1.98)²⁸	$8.81 ($7.93–$9.70)^*	0.7 (active bleeding)¹⁵	0.20 (thrombocytopenia)²⁹
						0.80 (intracranial hemorrhage)³⁰
						2.20 (serious extracranial hemorrhage)³¹
Thrombolysis with streptokinase	STEMI	21.7^BRIG^§	0.75 (0.71–0.79)¹⁴	$2588 ($2329–$2846)³²	6.80 (multiple^ǁ)³³	0.31 (intracranial hemorrhage)³⁴
Thrombolysis with streptokinase						0.41 (death attributable to thrombolysis)³⁴
PCI	STEMI	27.8^BRIG	0.50 (0.35–0.71)¹⁴	$5253 ($4728–$5779)^¶	10.0 (ineligible patients)³⁵	0.53 (death attributable to PCI)³⁶
PCI	NSTEMI	25.0^BRIG	0.75 (0.63–0.90)³⁷	$5253 ($4728–$5779)^¶	10.0 (ineligible patients)³⁵	0.53 (death attributable to PCI)³⁶

Ranges in parentheses were used in sensitivity analyses. ACEIs indicates angiotensin-converting enzyme inhibitors; AMI, acute myocardial infarction; BRIG, Bridging the Gap in Coronary Heart Disease Secondary Prevention in China Project; CI, confidence interval; NSTEMI, non–ST-segment–elevation myocardial infarction; PCI, percutaneous coronary interventions; and STEMI, ST-segment–elevation myocardial infarction.

Data from maximum retail price for each essential medicine set by the Evaluation Center of Drug Pricing, National Development and Reform Commission.

^†

Case fatality rate of intracranial hemorrhage (40.7%) was from the average rate from 1999 to 2004 in the Sino-MONICA-Beijing Project.

^‡

Severe chronic obstructive pulmonary disease (1.8%), heart failure (pulmonary edema 1.0%, cardiogenic shock 1.0%), second- or third-degree heart block on the initial ECG (1.5%), and bradycardia-hypotension syndrome (17%).

^§

Utilization rate of thrombolytic agents.

^ǁ

Hypertension (blood pressure >180/110 mm Hg), recent surgery or trauma, recent gastrointestinal or genitourinary bleeding, stroke, and bleeding diathesis.

^¶

Cost was estimated by the data from China’s Health Statistics Yearbook and Beijing Public Health Information Center.