Table 3.
Single Treatments Analysis: Simulated Cost and Effectiveness of Optimal Use of Selected Individual Hospital-Based Treatment Strategies for Patients With AMI in China
| In-Hospital AMI Deaths (in the Acute Stage) |
Prevented In- Hospital AMI Deaths |
In-Hospital AMI Case Fatality Rate, % |
Total No. of Annual CHD Deaths |
Prevented CHD Deaths |
CHD Mortality Rate (1/100 000) |
Increased QALYs (1000s) |
Increased Acute Treatment Costs (1000s) |
Increased Total Healthcare Costs (1000s) |
Cost-Effectiveness (Compared With Base Case) |
|---|---|---|---|---|---|---|---|---|---|
| Current utilization (base case) | |||||||||
| 255 600 | — | 26.8 | 649 200 | — | 95.7 | — | — | — | — |
| Strategy A1: the 4 oral drugs in patients with AMI* | |||||||||
| 245 800 | 9800 | 25.7 | 640 300 | 8900 | 94.4 | 22 | $34 952 | $67 764 | $3100 |
| Strategy A2: clopidogrel in patients with AMI | |||||||||
| 252 400 | 3200 | 26.4 | 646 300 | 3000 | 95.3 | 7 | $112 533 | $123 363 | $17 600 |
| Strategy B: unfractionated heparin in patients with NSTEMI | |||||||||
| 253 700 | 1900 | 26.6 | 647 500 | 1800 | 95.4 | 4 | $5011 | $11 370 | $2800 |
| Strategy C1: PCI in tertiary hospitals and thrombolysis with streptokinase in secondary hospitals in patients with STEMI | |||||||||
| 219 300 | 36300 | 23.0 | 616 000 | 33 200 | 90.8 | 81 | $610 268 | $731 779 | $9000 |
| Strategy C2: primary PCI in all patients with STEMI | |||||||||
| 202 000 | 53 600 | 21.2 | 600 100 | 49 100 | 88.5 | 120 | $1 099 239 | $1 278 357 | $10 700 |
| Strategy C3: primary PCI in high-risk patients with NSTEMI in tertiary hospitals | |||||||||
| 252 300 | 3300 | 26.4 | 646 200 | 3000 | 95.3 | 7 | $152 974 | $163 551 | $23 400 |
AMI indicates acute myocardial infarction; CHD, coronary heart disease; NSTEMI, non–ST-segment–elevation myocardial infarction; PCI, primary percutaneous coronary intervention; QALYs, quality-adjusted life years; and STEMI, ST-segment–elevation myocardial infarction.
*
Aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and statins.