TY - JOUR
T1 - Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries
AU - Lunardi, Mattia
AU - Mamas, Mamas A.
AU - Mauri, Josepa
AU - Molina, Carmen Medina
AU - Rodriguez-Leor, Oriol
AU - Eggington, Simon
AU - Pietzsch, Jan B.
AU - Papo, Natalie L.
AU - Walleser-Autiero, Silke
AU - Baumbach, Andreas
AU - Maisano, Francesco
AU - Ribichini, Flavio L.
AU - Mylotte, Darren
AU - Barbato, Emanuele
AU - Piek, Jan J.
AU - Wijns, William
AU - the We CARE Initiative
AU - Naber, Christoph K.
N1 - Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Aims As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications. This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. Methods and results Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group. STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (−1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. Conclusion The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
AB - Aims As a consequence of untimely or missed revascularization of ST-elevation myocardial infarction (STEMI) patients during the COVID-19 pandemic, many patients died at home or survived with serious sequelae, resulting in potential long-term worse prognosis and related health-economic implications. This analysis sought to predict long-term health outcomes [survival and quality-adjusted life-years (QALYs)] and cost of reduced treatment of STEMIs occurring during the first COVID-19 lockdown. Methods and results Using a Markov decision-analytic model, we incorporated probability of hospitalization, timeliness of PCI, and projected long-term survival and cost (including societal costs) of mortality and morbidity, for STEMI occurring during the first UK and Spanish lockdowns, comparing them with expected pre-lockdown outcomes for an equivalent patient group. STEMI patients during the first UK lockdown were predicted to lose an average of 1.55 life-years and 1.17 QALYs compared with patients presenting with a STEMI pre-pandemic. Based on an annual STEMI incidence of 49332 cases, the total additional lifetime costs calculated at the population level were £36.6 million (€41.3 million), mainly driven by costs of work absenteeism. Similarly in Spain, STEMI patients during the lockdown were expected to survive 2.03 years less than pre-pandemic patients, with a corresponding reduction in projected QALYs (−1.63). At the population level, reduced PCI access would lead to additional costs of €88.6 million. Conclusion The effect of a 1-month lockdown on STEMI treatment led to a reduction in survival and QALYs compared to the pre-pandemic era. Moreover, in working-age patients, untimely revascularization led to adverse prognosis, affecting societal productivity and therefore considerably increasing societal costs.
KW - COVID-19
KW - Myocardial infarction
KW - Quality of life
KW - health economy
UR - http://www.scopus.com/inward/record.url?scp=85182500882&partnerID=8YFLogxK
U2 - https://doi.org/10.1093/ehjqcco/qcad025
DO - https://doi.org/10.1093/ehjqcco/qcad025
M3 - Article
C2 - 37286294
SN - 2058-5225
VL - 10
SP - 25
EP - 35
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
IS - 1
ER -