Real-World Evaluation of a Pharmacoinvasive Strategy for STEMI in Latin America: A Cost-Effective Approach with Short-Term Benefits

• Published in: Therapeutics and clinical risk management Vol. 19; pp. 903 - 911
• Main Authors: Arias-Mendoza, Alexandra, Ortega-Hernández, Jorge, Araiza-Garaygordobil, Diego, González-Pacheco, Héctor, Martínez-García, Mireya, Hernández-Lemus, Enrique, Gopar-Nieto, Rodrigo, Sandoval-Aguilar, Tomás Tadeo, Sierra-Lara Martinez, Daniel, Mendoza-García, Salvador, Altamirano-Castillo, Alfredo, Briseño-de-la-Cruz, José Luis, Ortega-Hernández, Midori, Soliz-Uriona, Luis Alejandro, Gaspar-Hernández, Jorge
• Format: Journal Article
• Language: English
• Published: Dove Medical Press Limited 30-11-2023; Dove Medical Press
• Subjects: Comparative analysis; cost-effectiveness; Health aspects; Heart attack; Latin America; Methods; Mexico; Mortality; pharmacoinvasive; stemi; Tenecteplase; Mexico; Latin America
• DOI: 10.2147/TCRM.S432683
• EISSN: 1178-203X
• ISSN: 1178-203X; 1176-6336

Purpose: 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