Cost-effectiveness of Interventions to Reduce Mortality of Myocardial Infarctions

描述（由申请人提供）：在心肌梗死患者中进行的经皮冠状动脉介入治疗（PCI）是最有效的再灌注策略。以最快的方式将患者送到导管室（门到球囊时间）已被证明可以降低死亡率。然而，及时获得PCI的能力可能受到递送延迟的限制。有几种策略量化了每种策略节省的分钟数，这些分钟数与死亡率的显著降低相关。这些策略的成本都是未知的。由于这些战略的成本和有效性各不相同，因此需要进行成本效益分析。该项目的总体目标是改善心肌梗死患者的健康，并最终将技术评估方法应用于急性心脏病护理领域，为最具成本效益的资源分配提供证据。该目标将通过解决以下具体目标来实现：（1）估计已证明可减少ST段抬高MI（STEMI）患者从入院到球囊扩张时间的策略的成本;以及（2）比较已证明可有效减少STEMI患者从入院到球囊扩张时间的策略的增量成本效益。为了确定实施和维护成本效益分析中使用的策略所需的投入/资源，将对从医院到气球的时间少于90分钟的医院领导进行访谈，然后对150家医院进行调查，以了解实施每项策略所需的估计成本和资源。其次，将建立一个成本效益模型，以评估减少从门到气球时间的不同战略。成本将输入模型。节省的时间相当于死亡率的降低，也将作为与每项战略相关的成果输入模型。确定每种策略的成本并根据文献建立模型后，将评估每种策略的增量成本效益，以减少门到气球的时间。将进行几项敏感性分析，以测试结果对模型中使用的假设和估计值变化的稳健性。研究结果可能表明，改变患者护理途径的资金和资源分配，以更经济有效地减少门到气球的时间，从而降低死亡率。此外，这些信息可能会影响政策制定者和付款人的决定，因为它将更全面地了解哪些策略最具成本效益。这将通过对每项战略进行评估而产生重要的积极影响，并可能有助于确定改进的成果是否值得与特定战略相关的潜在增加成本。

DESCRIPTION (provided by applicant): Percutaneous coronary intervention (PCI) performed in patients having myocardial infarctions is the most effective reperfusion strategy. Getting the patient to the catheterization lab (door-to-balloon time) in the quickest manner has proven to decrease mortality. The ability to obtain timely PCI, however, may be limited by delays in delivery. Several strategies have quantified minutes saved per strategy associated with significant reduction in mortality. Costs of each of these strategies are unknown. Due to the significantly different costs and different effectiveness of each these strategies, a cost-effective analysis needs to be done. The over all goal of this project is to improve the health of patients presenting with myocardial infarctions and ultimately, to apply technology assessment methods to the field of acute cardiac care to provide evidence for the most cost-effective allocation of resources. The goal will be accomplished by addressing the following specific aims: (1) estimate costs of strategies shown to reduce door-to-balloon times for patients with ST-elevated Ml (STEMIs); and (2) compare the incremental cost-effectiveness of strategies shown to be effective in reducing door-to-balloon times in patients with STEMIs. To determine the inputs/resources necessary to implement and maintain the strategies that will be used in the cost-effective analysis, hospital leaders whose door-to-balloon times are less than 90 minutes will be interviewed and then 150 hospitals will be surveyed to gain the knowledge of the estimated costs and resources needed to implement each of the strategies. Secondly, a cost-effectiveness model will be developed to evaluate the different strategies that reduce door to balloon time. Cost will be inputted into the model. Time-saved, which equates to a decrease in mortality, will also be inputted into the model as the outcomes associated with each of the strategies. With the costs of each strategy determined and a model built based on the literature, incremental cost-effectiveness of each strategy shown to reduce door-to-balloon time will be evaluated. Several sensitivity analyses will be conducted to test the robustness of the results to changes in the assumptions and estimates used in the model. Findings may suggest changes in funding patient care pathways and changes in allocation of resources to more cost-effectively reduce door-to-balloon times and therefore mortality. Additionally, this information is likely to influence policy makers and payer decisions, as it will give a more complete picture of which strategies are the most cost-effective. This will have an important positive impact by placing a value on each strategy and may help determine if the improved outcomes are worth the potential increased cost associated with the specific strategy.