Table 4.
Incremental Analysis: Simulated Cost-Effectiveness of Combined Strategies for Optimal Use of Hospital-Based Treatment Strategies for Patients With AMI in China
| In-Hospital AMI Deaths Prevented |
QALYs (1000s) |
Annual Healthcare Costs (1000s) |
ICER* | 95% Uncertainty Interval† |
Comparator | Percent Moderately Cost Effective |
Percent Very Cost Effective |
|---|---|---|---|---|---|---|---|
| Current utilization (base case) | |||||||
| — | 674 058 | $583 613 093 | — | — | — | — | — |
| Strategy A1 (4 oral drugs in patients with AMI)‡ | |||||||
| 9800 | 674 080 | $583 680 857 | Dominated by A1 +B§ |
— | Base case | — | — |
| Strategy A1+B (unfractionated heparin in patients with NSTEMI) | |||||||
| 11 700 | 674 084 | $583 692 227 | $3000 | $1900–4400 | Base case | 99.4% | 97.7% |
| Strategy A1+B+A2 (clopidogrel in patients with AMI) | |||||||
| 14 900 | 674 091 | $583 815 590 | Dominated by A1+B+C1 |
— | A1+B | — | — |
| Strategy A1+B+C1 (PCI in tertiary hospitals and thrombolysis with streptokinase in secondary hospitals in patients with STEMI) | |||||||
| 48 000 | 674 166 | $584 424 005 | $8900 | $6400–19 300 | A1+B | 92.7% | 0.8% |
| Strategy A1+B+C1+C3 (primary PCI in high-risk patients with NSTEMI in tertiary hospitals) | |||||||
| 51 300 | 674 173 | $584 587 556 | $23 400 | $18 000–29 500 | A1+B+C1 | 1.6% | 0.0% |
AMI indicates acute myocardial infarction; ICERs, incremental cost-effectiveness ratios; NSTEMI, non–ST-segment–elevation myocardial infarction; PCI, primary percutaneous coronary intervention; QALYs, quality-adjusted life years; and STEMI, ST-segment–elevation myocardial infarction.
Each strategy was compared with the base case or prior most cost-effective strategy. ICERs were calculated as incremental change in total healthcare costs divided by incremental change in QALYs. Results were rounded to the nearest 100.
The 95% uncertainty interval of the ICERs from the result of probabilistic sensitivity.
Aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and statins.
Dominated strategies are both less effective and more costly when compared with the extension. That is, although full implementation of the next strategy (row below in table) would need more investment than the dominated strategy, partial implementation of the next strategy would cost the same amount as but will be more effective than full implementation of the dominated strategy.