title: Cost-effectiveness of a European ST-segment elevation myocardial infarction network: results from the Catalan Codi Infart network.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of the ST-segment elevation myocardial infarction (STEMI) network of Catalonia (Codi Infart).
  
  
  METHODS
  Cost-utility analysis.
  
  
  METHODS
  The analysis was from the Catalonian Autonomous Community in Spain, with a population of about 7.5 million people.
  
  
  METHODS
  Patients with STEMI treated within the autonomous community of Catalonia (Spain) included in the IAM CAT II-IV and Codi Infart registries.
  
  
  METHODS
  Costs included hospitalisation, procedures and additional personnel and were obtained according to the reperfusion strategy. Clinical outcomes were defined as 30-day avoided mortality and quality-adjusted life-years (QALYs), before (N=356) and after network implementation (N=2140).
  
  
  RESULTS
  A substitution effect and a technology effect were observed; aggregate costs increased by 2.6%. The substitution effect resulted from increased use of primary coronary angioplasty, a relatively expensive procedure and a decrease in fibrinolysis. Primary coronary angioplasty increased from 31% to 89% with the network, and fibrinolysis decreased from 37% to 3%. Rescue coronary angioplasty declined from 11% to 4%, and no reperfusion from 21% to 4%. The technological effect was related to improvements in the percutaneous coronary intervention procedure that increased efficiency, reducing the average length of the hospital stay. Mean costs per patient decreased from €8306 to €7874 for patients with primary coronary angioplasty. Clinical outcomes in patients treated with primary coronary angioplasty did not change significantly, although 30-day mortality decreased from 7.5% to 5.6%. The incremental cost-effectiveness ratio resulted in an extra cost of €4355 per life saved (30-day mortality) and €495 per QALY. Below a cost threshold of €30,000, results were sensitive to variations in costs and outcomes.
  
  
  CONCLUSIONS
  The Catalan STEMI network (Codi Infart) is cost-efficient. Further studies are needed in geopolitical different scenarios.
authors.affiliation: Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Universitat de Barcelona, Barcelona, Spain Iniciativa Stent for Life, Spain.
authors.forename: Ander
authors.identifier: http://orcid.org/0000-0001-5201-447X
authors.initials: A
authors.lastname: Regueiro
authors.affiliation: Centro de Investigación en Economía y Salud, Universidad Pompeu Fabra, Barcelona, Spain.
authors.forename: Julia
authors.initials: J
authors.lastname: Bosch
authors.affiliation: Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín-Yuste
authors.affiliation: Departament de Salut, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Rosas
authors.affiliation: Departament de Salut, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Faixedas
authors.affiliation: Servicio de Cardiología, Hospital Universitari Bellvitge, Barcelona, Spain.
authors.forename: Joan Antoni
authors.initials: JA
authors.lastname: Gómez-Hospital
authors.affiliation: Servicio de Cardiología, Hospital Vall d´Hebron, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.affiliation: Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Curós
authors.affiliation: Servicio de Cardiología, Hospital Universitari Bellvitge, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Iniciativa Stent for Life, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Goicolea
authors.affiliation: Iniciativa Stent for Life, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Ortiz
authors.affiliation: Iniciativa Stent for Life, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Macaya
authors.affiliation: Departament de Salut, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Tresserras
authors.affiliation: Centro de Investigación en Economía y Salud, Universidad Pompeu Fabra, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Pellisé
authors.affiliation: Servicio de Cardiología, Hospital Clínic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer IDIBAPS, Universitat de Barcelona, Barcelona, Spain Iniciativa Stent for Life, Spain.
authors.forename: Manel
authors.initials: M
authors.lastname: Sabaté
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality* / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000191:economics*; D019057:Quality-Adjusted Life Years; D012042:Registries; D013030:Spain
keywords: HEALTH ECONOMICS