Routing ambulances to cardiac surgery-equipped hospitals more cost-effective than building more such hospitals
For heart attack patients with a coronary artery totally blocked by a blood clot (ST-segment elevation myocardial infarction or STEMI), cardiac surgery, if administered in a timely manner, is better at reducing mortality than clot-busting (fibrinolytic) therapy. Far fewer than 80 percent of eligible patients actually receive percutaneous coronary intervention (PCI) surgery, although 80 percent of the U.S. population lives within a 1-hour drive of a PCI-capable hospital.
To improve access to these hospitals, an enhanced emergency medical services (EMS) strategy of transporting all STEMI patients to existing facilities would be less costly and more effective than a hospital expansion strategy, according to a new study examining the comparative effectiveness of the two strategies. Only if the average cost per diverted patient rose to more than $19,769 (a 20-fold increase) would an EMS-based strategy no longer be the most cost-effective one. Detection of patients with STEMI in the EMS system and diversion to PCI-capable hospitals have been shown to be both safe and effective.
Using their own triage and allocation model, the researchers estimated incremental treatment costs and quality-adjusted life expectancies of 2,000 patients with STEMI who received PCI or fibrinolytic therapy in simulations of emergency care in a regional hospital system. They compared a base case strategy with 12 hospital-based strategies of building new PCI laboratories or extending the hours of existing laboratories with one EMS-based strategy of transporting all STEMI patients to existing PCI-capable hospitals. The EMS-based strategy was less costly and more effective than all hospital expansion options. The study was partly supported by the Agency for Healthcare Research and Quality (T32 HS00060, HS10282).
See "Comparative effectiveness of ST-segment elevation myocardial infarction regionalization strategies," by Thomas W. Concannon, Ph.D., David M. Kent, M.D., M.S., Sharon-Lise Normand, Ph.D., and others in the September 1, 2010, Circulation: Cardiovascular Quality and Outcomes 3(5), pp. 506-513.
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