Determining the Cost Economic "Tipping Point" for the Addition of a Regional Percutaneous Coronary Intervention Facility

Background: The preferred reperfusion strategy for ST-segment elevation myocardial infarction (STEMI) is percutaneous coronary intervention (PCI) provided it can be performed in a timely fashion at an expert 24/7 facility. However, many Canadians reside in areas precluding timely transport to a specialized facility. A new regional PCI facility could be economically viable if implementation costs are at least comparable to urgent transportation and interventional team clinical competency is maintained. Objectives: Provide a cost economic model for assisting decisions regarding addition of a regional PCI facility. Methods: We used the following in the model: (1) PCI laboratory construction costs, (2) ambulance transportation costs, (3) procedural costs, and (4) expected clinical volume. We compared expected per PCI cost of air transportation vs deploying a regional facility based on population and distance from an existing centre. Results: Potential cost economic advantages exist for establishing new PCI centres with decreasing minimum populations of 208,100, 141,900, and 110,000 located at increasing distances of 150 km, 300 km, and 450 km, respectively, from the existing tertiary PCI centres. Sensitivity analyses suggest that regions with modest populations of approximately 200,000 located at these distances may be economically attractive. Conclusions: The derived algorithm can be used to assess the economics component of establishing regional PCI laboratories and identify opportunities for extending access for primary PCI. This model presents a means for evaluating the economic implications of constructing a new facility. Additional components such as staffing and patient preferences for location of care also require consideration.