ST segment elevation myocardial infarction (STEMI) is a major cause of death. Recent evidences showed that primary percutaneous coronary intervention (PPCI) can reduce mortality rate. However, in a situation where PPCI is unavailable, facilitated percutaneous coronary intervention (FPCI) using fibrinolytic drug before patient referral could be an important life-saving solution. Since FPCI may increase the risk of major bleeding and it incurred more expenditure, the information on cost-effectiveness of FPCI is useful for policy makers.
A Markov model was used to compare the lifetime cost and quality-adjusted life years (QALYs) accrued to patients receiving FPCI before referral or PPCI at referral center from societal and health system perspective. All analyses were performed using Microsoft Excel. Input data were retrieved from literatures and electronic databases.
We found that FPCI program at community hospital is a dominant alternative given its lower cost and higher effectiveness than PPCI at referral center. This means it is a cost-effective policy option.
Therefore, community hospitals with the capacity to provide FPCI service for STEMI patients should be supported to offer such service for better access to the patients with higher overall quality of life and lower costs to the systems. We suggest that policy makers in the Ministry of Public Health and the hospital administrators should consider these findings and provide support to make FPCI available in community hospitals with existing capacity. Capacity strengthening particularly in terms of manpower, and budget should be provided especially in the areas where there is still shortage of supply.