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

Abstract

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.