Therapeutics and Clinical Risk Management (Nov 2023)
Real-World Evaluation of a Pharmacoinvasive Strategy for STEMI in Latin America: A Cost-Effective Approach with Short-Term Benefits
Abstract
Alexandra Arias-Mendoza,1 Jorge A Ortega-Hernández,1 Diego Araiza-Garaygordobil,1 Héctor González-Pacheco,1 Mireya Martínez-García,2 Enrique Hernández-Lemus,3 Rodrigo Gopar-Nieto,1 Tomás Tadeo Sandoval-Aguilar,1 Daniel Sierra-Lara Martinez,1 Salvador Mendoza-García,1 Alfredo Altamirano-Castillo,1 José Luis Briseño-de-la-Cruz,1 Midori Alondra Ortega-Hernández,4 Luis Alejandro Soliz-Uriona,1 Jorge Gaspar-Hernández5 1Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; 2Immunology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico; 3Computational Genomics, Instituto Nacional de Medicina Genómica, Mexico City, Mexico; 4Facultad de Ciencias, Universidad Nacional Autónoma de México, Mexico City, Mexico; 5Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, MexicoCorrespondence: Alexandra Arias-Mendoza, Coronary Care Unit, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano, Sección XVI, 14080, Tlalpan, Mexico City, Mexico, Tel +52-55- 54852219, Fax +52-55-54852219, Email [email protected]: While pharmacoinvasive strategy (PI) is a safe and effective approach whenever access to primary percutaneous intervention (pPCI) is limited, data on each strategy’s economic cost and impact on in-hospital stay are scarce. The objective is to compare the cost-effectiveness of a PI with that of pPCI for the treatment of ST-elevation myocardial infarction (STEMI) in a Latin-American country.Patients and Methods: A total of 1747 patients were included, of whom 470 (26.9%) received PI, 433 (24.7%) pPCI, and 844 (48.3%) NR. The study’s primary outcome was the incremental cost-effectiveness ratio (ICER) for PI compared with those for pPCI and non-reperfused (NR), calculated for 30-day major cardiovascular events (MACE), 30-day mortality, and length of stay.Results: For PI, the ICER estimates for MACE showed a decrease of $– 35.81/per 1% (95 confidence interval, – 114.73 to 64.81) compared with pPCI and a decrease of $– 271.60/per 1% (95% CI, – 1086.10 to – 144.93) compared with NR. Also, in mortality, PI had an ICER decrease of $– 129.50 (95% CI, – 810.57, 455.06) compared to pPCI and $– 165.27 (– 224.06, – 123.52) with NR. Finally, length of stay had an ICER reduction of − 765.99 (− 4020.68, 3141.65) and − 283.40 (− 304.95, − 252.76) compared to pPCI and NR, respectively.Conclusion: The findings of this study suggest that PI may be a more efficient treatment approach for STEMI in regions where access to pPCI is limited or where patient and system delays are expected.Keywords: pharmacoinvasive, cost-effectiveness, STEMI, Latin-America
