Heart Center Rostock, Universitätsklinikum Rostock, Ernst-Heydemann-Str, 6, 18057, Rostock, Germany.
Health Econ Rev. 2013 Apr 8;3(1):10. doi: 10.1186/2191-1991-3-10.
Myocardial infarction networks have been shown to improve guideline adherent therapy and outcomes in patients presenting with acute ST-elevation myocardial infarction (STEMI). Our objective was to assess the short term cost effectiveness of a network structure.
Outcome data and reimbursement data for the index hospital stay were gathered in consecutive patients with acute STEMI (n = 536) admitted to any of the hospitals in a 350.000 inhabitant rural network area during the years 2002 (n = 185), 2005 (n = 163) and 2008 (n = 188). Network structure was established between 2002 and 2005 aiming for identical treatment of all acute STEMI patients during 24 h/7d a week with primary angioplasty. Patient baseline characteristics in the different years were quite comparable. From 2002 to 2005 regional hospital mortality in STEMI patients decreased from 16% to 9%. Lower mortality under network conditions was confirmed in 2008. Reimbursement data of different years were standardized to exclude effects not induced by the network. The mean initial costs per saved live during the index stay were €7727 with a 95%-confidence interval of €-3.500 to €36.700 (referenced to the German reimbursement in 2005).
The short term cost effectiveness of a myocardial infarction network organisation is within well accepted boundaries under conditions of the German reimbursement system.
心肌梗死网络已被证明可以改善急性 ST 段抬高型心肌梗死（STEMI）患者的指南依从性治疗和结局。我们的目的是评估网络结构的短期成本效益。
连续收集了 2002 年（n=185）、2005 年（n=163）和 2008 年（n=188）在一个拥有 35 万居民的农村网络区域内任何一家医院就诊的急性 STEMI 患者的住院结局数据和指数住院期间的报销数据。2002 年至 2005 年期间建立了网络结构，目标是在每周 24 小时/7 天内对所有急性 STEMI 患者进行相同的治疗，采用直接经皮冠状动脉介入治疗。不同年份的患者基线特征相当可比。从 2002 年到 2005 年，STEMI 患者的区域医院死亡率从 16%下降到 9%。在 2008 年，网络条件下死亡率较低得到了证实。不同年份的报销数据已标准化，以排除非网络因素的影响。指数住院期间每挽救一条生命的平均初始成本为 7727 欧元，95%置信区间为-3500 至 36700 欧元（参考 2005 年德国报销标准）。
在德国报销制度的条件下，心肌梗死网络组织的短期成本效益在可接受的范围内。
