Abstract
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, a 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 incur 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 and PPCI at referral center from societal and health
system perspectives. 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.
