Myocardial infarction: keeping uncomplicated cases in hospital for > 72 hours was not very cost-effective

Clinical bottom line (level 2b)

  1. The cost-effectiveness of keeping patients with an uncomplicated myocardial infarction in hospital for more than 72 hours was low.
Newby et al: N Engl J Med 2000; 342 : 749-755
Expires March 2004

The study

cost-effectiveness study using a decision-analysis model
Setting: acute hospitals, worldwide

patients with an uncomplicated myocardial infarction after 72 hours (no death, reinfarction, congestive heart failure, recurrent ischaemia, shock, stroke, emergeny revascularisation or cardioversion) from GUSTO-1 randomised controlled trial

  • Viewpoint: ?third party (e.g. NHS or HMO healthcare provider)
  • Benefit assessment: length of stay in hospital
  • Resources and costs: hospital resources calcaulated from GUSTO-1 cost-effectiveness analysis and the Duke Transition One cost-accounting system. All costs in 1997 US dollars.
  • Sensitivity analysis: Costs were adjusted for prevalence and success of resuscitation from ventricular arrhythmias, additional days in hospital, recurrent ischaemic events, adding follow-up telephone calls

    The evidence

    intervention cost
    cost-effectiveness per year of life saved for an additional day of hospitalisation $105629

    Effect of sensitivity analysis: Sensitivity analysis led to variation in the cost-effectiveness of an additional day in hospital from $65777 to $145967 per year of life saved

    Comments

    1. The analysis assumes that the only reason patients without complication stay in longer than 72 hours was to provide prompt resuscitation in case of cardiac arrest. Secondly it assumes that discharged patients who developed complications could return rapidly to hospital.
    2. After 72 hours, 16/22361 patients had ventricular arrhythmias (0.072%).
    3. Though early discharge appears to be more cost-effective than keeping patients in hospital from this analysis, this policy needs to be assessed prospectively in a group of willing patients.

    Citation

    1. Newby LK, Eisenstein EL, Califf RM, et al: cost effectiveness of early discharge after uncomplicated myocardial infarction. N Engl J Med 2000; 342 : 749-755
    Search Terms: from ACP Journal Club
    Contributor: Chris Ball, March 2002
    Reviewer:

    Clinical Question.
    Patient uncomplicated acute myocardial infarction
    Intervention or Exposure stay in hospital for > 72 hours
    Outcome cost-effectiveness