Pre-hospital ECG for Patient with ST-Segment Elevation Myocardial Infarction (STEMI) in Taiwan: An Economic Evaluation

• Main Authors: Yao-Chi Channg, 張曜吉
• Other Authors: Ming-Chin Yang
• Format: Others
• Language: zh-TW
• Published: 2018
• Online Access: http://ndltd.ncl.edu.tw/handle/vaf6x2

碩士 === 國立臺灣大學 === 公共衛生碩士學位學程 === 106 === Background: In Taiwan, approximately 20,000 people a year experienced acute myocardial infarction (AMI) and the incidence rate is increasing year by year. Some patients suffering from this condition cannot be saved. The medical expenses and social and economic losses caused by the worsening or death from the disease are enormous. In recent years, with the development of information technology, some cities in Taiwan have implemented pre-hospital electrocardiogram systems (PHECG) to detect suspected myocardial infarction patients as early as possible and notify emergency departments to prepare for emergent catheterization before patients arrived at the hospital. At present, there is no research focusing on the effects of using PHECG on medical quality, medical care utilization and economic assessment. Objective: The aim of this study was to compare the differences in medical quality and medical care utilization between ST-segment elevation myocardial infarction (STEMI) patients who used PHECG and those who didn&apos;&apos;t. And to analyze the cost effectiveness and economic assessment of using PHECG. Methods: This study used the cardiac catheterization database of a medical center in southern Taiwan. We enrolled patients who used PHECG and were found to be suffering from STEMI and those who did not use PHECG from January 2012 to July 2017. We compared the difference of the door-to-balloon time (D2B time), the Ischemic-to-balloon time (I2B time), the rate of D2B time less than the 90mins, the death rate, the number of ICU days, the number of hospital days, the costs of health insurance payments and the costs of actual medical expenses. The chi-square test, Mann-Whitney U test, Logistic regression and Linear regression were used to compare the difference in outcomes and costs. Incremental cost-effectiveness ratio (ICER) was calculated from the perspectives of society, the city government, and National Health Insurance Administration (NHIA) with regard to the cost per life saved and per life year saved. Result: There were 68 patients of this study, including PHECG group of 26 and Non-PHECG group of 42 people. There were no differences in the baseline characteristics between these two groups. The mean D2B time was 47.2 minutes in the intervention group, 86.6 minutes in the control group (p< 0.001). The rate of D2B time less than the 90mins was 25 (96.1%) for the intervention group and 31(73.8%) for the control group (p = 0.022). In addition, there was no statistically significant difference in the in-hospital mortality rate, the I2B time, the number of ICU days, the number of hospital days, the costs of health insurance payments and the costs of actual medical expenses in the two groups. Conclusion: This study found that the use of PHECG group for the D2B time and the D2B time has less than 90 minutes had better outcomes, and also lower medical costs than Non-PHECG group. Therefore, the use of PHECG was a dominant modality in patients with STEMI. It is estimated that a total reduction of 14.2 deaths annually will be achieved in Kaohsiung City. The results of economic evaluation show that in terms of incremental cost for per live saves, the ICER for the perspectives of the society, the city government, and the NHIA were NT$477,234, 75,905, and 24,135 respectively. In terms of the incremental cost per life year saved, the ICER for the perspectives of the society, the city government, and the NHIA were NT$30,969, 4,926, and 1,566 respectively.