TITLE OF PAPER:

Is primary angioplasty cost-effective? The costs and cost effectiveness of the National Infarct Angioplasty Project Pilots (NIAPP).
Author(s) Title (Dr, Mr etc), Professional Grade and Hospital (underline name of presenter)
(This information will appear in Conference Programme if abstract is selected)
Dr Allan Wailoo, Senior Lecturer, Health Economics and Decision Science, University of Sheffield
Dr Monica Hernandez, Lecturer, Department of Economics, University of Sheffield
Professor Steve Goodacre, Medical Care Research Unit, University of Sheffield
Ms Fiona Sampson, Emergency and Immediate Care, University of Sheffield
MAILING ADDRESS:
Health Economics and Decision Science, ScHARR, Regent Court, 30 Regent Street, University of Sheffield, S1 4DA
E-Mail: Telephone: 0114 2220729 Fax: 0114 2724095
My preferred format for the presentation of this abstract is (please tick):
ORAL ü POSTER □
FOR TRAINEES ONLY
I wish my abstract to be considered for the Roderick Little Prize. (Trainees only)
YES NO

Name of PRINCIPAL AUTHOR: Allan Wailoo

Date: 16 April 2008

When completed, abstract forms should be emailed to

Please use your surname followed by the word ‘abstract’ as the subject heading for the email

Abstract forms must be received by deadline of 18th April 2008

The authors’ names will be removed from the abstracts before being reviewed by the Research Committee. Abstracts will be judged by their scientific validity, importance, and relevance to Emergency Medicine. Authors will receive notification of acceptance/rejection by the end of July.

The authors of the highest rated Abstracts submitted for oral presentation will be invited to give presentations during the Free Paper sessions. Other work will be invited in poster format, with the highest ranked posters also being invited to take place in a Moderated Poster session. Space for posters is limited, so we anticipate that the abstract rejection rate will be higher than in previous years.

To give Emergency Medicine Trainees (junior doctors) an opportunity to demonstrate their work, the Roderick Little Prize Session has been reserved for their presentations.

Page 1/2

AUTHOR(S): A J Wailoo, M Hernandez, S Goodacre, F Sampson
ADDRESS: Health Economics and Decision Science, ScHARR, University of Sheffield, Regrent Court, 30 Regent Street, Sheffield. S1 4DA
EMAIL:
BODY OF ABSTRACT: (The abstract must be typed single-spaced and include no more than 300 words. Do not use a type size smaller than 10pt. Do not change the size of the text box. Do not include references. One Table or Figure is, acceptable).
TITLE: Is primary percutaneous coronary intervention (PPCI) cost-effective? The costs and cost effectiveness of the National Infarct Angioplasty Project (NIAP).
Background: PPCI may offer clinical benefits over thrombolysis but may be more costly and require specialist staff and facilities. We aimed to estimate the cost-effectiveness of PPCI.
Method: Between April 2005 and March 2006, hospitals participating in the National Infarct Angioplasty Project (NIAP) collected information on all patients presenting with ST elevation MI. We used these data along with additional data from five control sites to estimate the costs and time to treatment of providing PPCI and thrombolysis in routine NHS practice. This was used to estimate the cost effectiveness of operating a comprehensive PPCI service compared to a thrombolysis-based service.
We used multilevel models to estimate the mean cost of thrombolysis and PPCI, adjusting for patient characteristics and treatment location. Survival analysis was used to estimate the time to treatment. These estimates were included in an existing model of cost effectiveness which synthesises evidence from 22 RCTs to estimate the short term rate of stroke, death, revascularisations and MI and then extrapolates over the long term using registry data.
Results: 67% received PPCI in the NIAP sites (from n=2083) vs. 16% controls (from n=919). The mean cost of the treatment episode for patients treated with thrombolysis was £3509 (control), £4361 (NIAP) compared to £5176 (PPCI). Overall the NIAP service had an incremental cost of £4440 per QALY gained, well below the NICE threshold of £20,000. Cost-effectiveness depended on the system used to access PPCI. Direct access to the PPCI hospital catheter laboratory was most cost-effective, whereas transfer from a non-PPCI centre resulted in thrombolysis-based care being dominant.
Conclusion: PPCI costs more than thrombolysis but is a cost-effective use of NHS resources. This conclusion does not hold if patients initially attend and then are transferred from a non-PPCI centre. Alternatives to transfer, such as direct access (bypassing the non PPCI-centre), should be considered.

Page 2/2