Cost-Effectiveness Analysis of Implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway.

Abstract

Due to the poor prognosis associated with acute coronary syndromes (ACSs), intensive low-density lipoprotein cholesterol (LDL-C) management therapy is recommended as early as possible after the onset of ACS, with the goal of lowering plasma LDL-C to < 70 mg/dL. The purpose of this study was to evaluate the cost-effectiveness of implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) using medical records (n = 385, pre-implementation group:224, post-implementation group:161) extracted from 8 hospitals in Nagasaki.Cost-effectiveness of implementing NASP was evaluated by a lifetime simulation using mathematical models. Drug costs for lipid-lowering therapy were calculated from actual prescriptions and treatment costs for each cardiovascular disease (CVD) event and utility scores were based on the literature. The risk of each CVD event was estimated by the equation consisting of the following variables: LDL-C, baseline CVD risks estimated using real-world clinical practice data, rate ratio per unit change in LDL-C and age. Implementation of NASP was evaluated as dominant, with an incremental gain of 0.058 quality-adjusted life years (QALYs) and expected cost savings of JPY 59,507 per person.Implementing NASP can be expected to reduce costs, in addition to increasing QALYs by preventing CVD. Further clinical and economic evaluation of long-term follow-up with a collaborative pathway to the general physician after discharge from the hospital is expected.