Cost-Effectiveness of Supersaturated Oxygen Delivery for Infarct Size Reduction in Patients With Anterior ST-Segment Elevation Myocardial Infarction.

BACKGROUND

Myocardial infarct size (IS) is a key determinant of long-term outcomes after acute myocardial infarction (MI). Although infusion of supersaturated oxygen (SSO2) after primary percutaneous coronary intervention (PPCI) has been shown to reduce IS among patients with acute anterior ST-segment elevation myocardial infarction (STEMI), the cost-effectiveness of this approach remains unknown.

METHODS

We developed a Markov model to project long-term mortality, quality of life, and costs among patients with acute anterior STEMI undergoing PPCI. Among surviving patients, we modeled the incidence of post-MI heart failure, cardiovascular death, and noncardiovascular death as a function of IS, using population-based data for calibration. Health state-specific costs were derived from Medicare data. The cost of SSO2 (including supplies, procedure time, and physician costs) was assumed to be $10,528. Deterministic and probabilistic sensitivity analyses were used to quantify the effects of uncertainty on the results.

RESULTS

In our base case analysis (mean age 61 years; 22% female; mean IS 25% of LV mass), treatment with SSO2 was projected to increase discounted life expectancy (14.21 vs 14.12 years) and quality-adjusted life expectancy (10.78 vs 10.69 quality-adjusted life-years [QALYs]) while increasing lifetime costs by $3205/patient. The incremental cost-effectiveness ratio for SSO2 vs standard care was $38,415/QALYs gained, which was sensitive to patient age, IS with standard care, and the impact of SSO2 on IS. For this population, the probability that SSO2 provides good economic value (at a societal willingness-to-pay threshold of $120,000/QALYs) was 73%.

CONCLUSIONS

Based on our disease simulation model, SSO2 therapy for patients undergoing PPCI for acute anterior STEMI appears to be a cost-effective adjunct to PPCI from the perspective of the US health care system.