The cost:benefit ratio of acute intervention for myocardial infarction: results of a prospective, matched pair analysis.
Parallel to the increased acceptance of intervention for acute myocardial infarction, there has been a decrease in financial resources and reimbursement. To ascertain the relative cost to benefit of intervention, we evaluated 78 matched pairs of acute myocardial infarction patients from a prospective data base of 507 consecutive patients presenting with infarction from May 1986 to July 1987. The pairs were matched for age (mean 61 years), sex (68% male), and infarct location (43% anterior). Intervention (thrombolytics and/or percutaneous transluminal coronary angioplasty [PTCA]) was only applied to patients at less than 6 hours from symptom onset. Nonintervention patients were subsequently considered for angiography and revascularization (PTCA, coronary artery bypass grafting [CABG]) based on clinical criteria. Clinical outcome was evaluated by in-hospital mortality and uncomplicated status (free of angina, heart failure, or arrhythmias) at 72 hours. Intervention was associated with decreased mortality (5.3% versus 13%, p = 0.16) and increased uncomplicated course (43% versus 19%, p less than 0.001) as compared with patients not receiving intervention. Hospital procedures for the intervention and nonintervention group were as follows: diagnostic cardiac catheterization (99% versus 51%); PTCA (60% versus 0%); and CABG (14% versus 19%), respectively. The mean cumulative hospital and professional charges were $31,684 for the intervention group and $29,022 for the nonintervention group (p = 0.50). In conclusion, despite the potential marked incremental expense of technology associated with intervention for acute myocardial infarction, this analysis demonstrates that benefit in clinical outcome can be derived without substantially increased costs.
Chapekis
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AT
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109-0022.
Burek
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K
Topol
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EJ
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006760:Hospitalization / Q000191:economics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D009204:Myocardial Revascularization; D011446:Prospective Studies
D005343:Fibrinolytic Agents