Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries.

Lunardi, Mattia; Mamas, Mamas A; Mauri, Josepa; Molina, Carmen Medina; Rodriguez-Leor, Oriol; Eggington, Simon; Pietzsch, Jan B; Papo, Natalie L; Walleser-Autiero, Silke; Baumbach, Andreas; Maisano, Francesco; Ribichini, Flavio L; Mylotte, Darren; Barbato, Emanuele; Piek, Jan J; Wijns, William; Naber, Christoph K; Güell-Viaplana, Francesc; Arjana, Lorena Bernàldez; Álvarez, Rosa Vidal; Solé, Aida Ribera

Abstract

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 49 332 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.

Citation

Lunardi, M., Mamas, M. A., Mauri, J., Molina, C. M., Rodriguez-Leor, O., Eggington, S., …Solé, A. R. (in press). Predicted clinical and economic burden associated with reduction in access to acute coronary interventional care during the COVID-19 lockdown in two European countries. European Heart Journal, Article qcad025. https://doi.org/10.1093/ehjqcco/qcad025

• Journal Article Type: Article
• Acceptance Date: May 11, 2023
• Online Publication Date: Jun 7, 2023
• Deposit Date: Jun 29, 2023
• Journal: European heart journal. Quality of care & clinical outcomes
• Print ISSN: 0195-668X
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Article Number: qcad025
• DOI: https://doi.org/10.1093/ehjqcco/qcad025
• Keywords: health economy, Quality of life, Myocardial infarction, COVID-19