title: Cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction.
abstract: Remote ischaemic conditioning seems to improve long-term clinical outcomes in patients undergoing primary percutaneous coronary intervention. Remote ischaemic conditioning can be applied with cycles of alternating inflation and deflation of a blood-pressure cuff. We evaluated the cost-effectiveness of remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction from the perspective of the Danish healthcare system.
  
  
  
  Between February 2007 and November 2008, 251 patients with ST-elevation myocardial infarction were randomly assigned to remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention (n=126) or to primary percutaneous coronary intervention alone (n=125). During a 4-year follow-up period, we used data from Danish medical registries and medical records to estimate within-trial cardiovascular medical care costs and major adverse cardiac and cerebrovascular event-free survival. After 4 years of follow-up, mean cumulative cardiovascular medical care costs were €2763 (95% confidence interval 207-5318, P=0.034) lower in the remote ischaemic conditioning group than in the control group (€12,065 vs. €14,828), while mean major adverse cardiac and cerebrovascular event-free survival time was 0.30 years (95% confidence interval 0.03-0.57, P=0.032) higher in the remote ischaemic conditioning group than in the control group (3.51 vs. 3.21 years). In the cost-effectiveness plane, remote ischaemic conditioning therapy was economically dominant (less costly and more effective) in 97.26% of 10,000 bootstrap replications.
  
  
  
  Remote ischaemic conditioning as an adjunct to primary percutaneous coronary intervention appears to be a cost-effective treatment strategy in patients with ST-elevation myocardial infarction.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark astrid.drivsholm@clin.au.dk.
authors.forename: Astrid D
authors.initials: AD
authors.lastname: Sloth
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Schmidt
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Kim
authors.initials: K
authors.lastname: Munk
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Schmidt
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
authors.forename: Henrik T
authors.initials: HT
authors.lastname: Sørensen
authors.affiliation: Department of Public Health, Aarhus University, Denmark.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Enemark
authors.affiliation: Department of Public Health, Aarhus University, Denmark.
authors.forename: Erik T
authors.initials: ET
authors.lastname: Parner
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Denmark.
authors.forename: Hans Erik
authors.initials: HE
authors.lastname: Bøtker
keywords: Remote ischaemic conditioning; ST-elevation myocardial infarction; cost-effectiveness analysis; ischaemia-reperfusion injury; primary percutaneous coronary intervention