Pre-hospital ECG for acute coronary syndrome in urban India: A cost-effectiveness analysis

BMC Cardiovascular Disorders

Research Article

Dorairaj Prabhakaran¹  Thomas A Gaziano²  Joshua Schulman-Marcus³ 

[1] Department of Cardiology, All-India Institute of Medical Sciences, New Delhi, India;Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, USA;Department of Health Policy and Management, Harvard School of Public Health, 02115, Boston, MA, USA;Mount Sinai School of Medicine, One Gustave L Levy Place, 10029, New York, NY, USA;

关键词: General Practitioner;    Acute Coronary Syndrome;    Emergency Medical Service;    Probabilistic Sensitivity Analysis;    Acute Coronary Syndrome Patient;   

DOI  :  10.1186/1471-2261-10-13

 received in 2009-05-21, accepted in 2010-03-12,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundPatients with acute coronary syndrome (ACS) in India have increased pre-hospital delay and low rates of thrombolytic reperfusion. Use of ECG could reduce pre-hospital delay among patients who first present to a general practitioner (GP). We assessed whether performing ECG on patients with acute chest pain would improve long-term outcomes and be cost-effective.MethodsWe created a Markov model of urban Indian patients presenting to a GP with acute chest pain to compare a GP's performing an ECG versus not performing one. Variables describing the accuracy of a GP's referral decision in chest pain and ACS, ACS treatment patterns, the effectiveness of thrombolytic reperfusion, and costs were derived from Indian data where available and other developed world studies. The model was used to estimate the incremental cost-effectiveness ratio (ICER) of the intervention in 2007 US dollars per quality adjusted life years (QALY) gained.ResultsUnder baseline assumptions, the ECG strategy cost an additional $12.65 per QALY gained compared to no ECG. Sensitivity analyses around the cost of the ECG, cost of thrombolytic, and referral accuracy of the GP yielded ICERs for the ECG strategy ranging between cost-saving and $1124/QALY. All results indicated the intervention is cost-effective under current World Health Organization recommendations.ConclusionsWhile direct presentation to the hospital with acute chest pain is preferable, in urban Indian patients presenting first to a GP, an ECG performed by the GP is a cost-effective strategy to reduce disability and mortality. This strategy should be clinically studied and considered until improved emergency transport services are available.

【 授权许可】

Unknown   
© Schulman-Marcus et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.