Cost-Effectiveness Analysis of Implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway

Q: What are the key findings of this study?

Implementing the NASP clinical pathway was dominant compared to no implementation, yielding an incremental gain of 0.058 QALYs and expected cost savings of JPY 59,507 per person.

Q: What is the clinical evidence from this study?

Population: Acute Myocardial Infarction (n=385). Intervention: Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) vs. No implementation of NASP. Primary outcome: Incremental cost-effectiveness ratio (ICER) (ICER Dominant).

Masaya Kurobe; Ataru Igarashi; Yosuke Yamanaka; Akihito Uda; Katsuya Mori; Sachie Inoue; Mizuki Yoshimura; S Ikeda; Koji Maemura

doi:10.1536/ihj.25-323

March 30, 2026International Heart JournalOpen Access

Cost-Effectiveness Analysis of Implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway

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Key result

The NASP intensive LDL-C pathway improves QALYs and saves ~60,000 JPY per patient vs standard care.

ICER Dominant
n=385

Why the study?

Intensive LDL-C management therapy is recommended early after acute coronary syndromes, but the cost-effectiveness of implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway needed evaluation.

Does the implementation of the NASP clinical pathway improve cost-effectiveness and QALYs in patients with acute myocardial infarction?

Key Points

To evaluate the cost-effectiveness of implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) for intensive low-density lipoprotein cholesterol (LDL-C) management.
Retrospective cost-effectiveness simulation using medical records from 8 hospitals in Nagasaki (n = 385; pre-implementation group: 224, post-implementation group: 161).
Model projected lifetime cardiovascular events, healthcare expenditures, and quality-adjusted life years (QALYs) alongside one-way and probabilistic sensitivity analyses.
Implementation of NASP significantly increased the achievement rate of LDL-C levels < 70 mg/dL from 37.2% pre-implementation to 54.6% post-implementation (P < 0.01).
In the base-case lifetime analysis, NASP was dominant, reducing total costs by JPY 59,507 per person (JPY 3,655,653 vs. JPY 3,715,160) and increasing health gains by 0.058 QALYs per person (8.447 vs. 8.389).
Probabilistic sensitivity analysis demonstrated a 94.5% probability of cost-effectiveness and an 89.2% probability of dominance at a willingness-to-pay threshold of 5,000,000 JPY/QALY.

Structured PICO

Does the implementation of the NASP clinical pathway improve cost-effectiveness and QALYs in patients with acute myocardial infarction?

P

Population

Patients with acute myocardial infarction (AMI) (mean age 69.5 years, 24.9% female)

I

Intervention

Implementation of the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) for intensive LDL-C management

C

Comparator

No implementation of NASP (pre-implementation standard of care)

O

Outcome

Cost-effectiveness (incremental cost-effectiveness ratio, quality-adjusted life years [QALYs], and costs)

Main Result

Effect estimate: ICER Dominant

Implementing a standardized secondary prevention clinical pathway for intensive LDL-C management in AMI patients is a dominant strategy that improves quality-adjusted life years while reducing overall healthcare costs.

Limitations

Did not assess the effectiveness of the clinical pathway after discharge
Long-term data, such as treatment intensification after discharge, were not taken into account
Event risk was estimated based on the UK CPRD database population due to limited Japanese data availability
Utility scores for each state were derived from international data
Analysis relied on literature-based values for state costs
Evaluated the effects of in-hospital NASP but did not assess the effectiveness of the clinical pathway after discharge (long-term data not taken into account).
Event risk for the analysis population was set by adjusting baseline event risk estimated from the UK CPRD database due to the limitation of Japanese data availability.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

Warrants routine NASP adoption in AMI care; confirms standardized intensive LDL-C pathways as dominant.

Abstract

Due to the poor prognosis associated with acute coronary syndromes (ACSs), intensive low-density lipoprotein cholesterol (LDL-C) management therapy is recommended as early as possible after the onset of ACS, with the goal of lowering plasma LDL-C to < 70 mg/dL. The purpose of this study was to evaluate the cost-effectiveness of implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) using medical records (n = 385, pre-implementation group:224, post-implementation group:161) extracted from 8 hospitals in Nagasaki.

Cite This Study

Kurobe et al. (2026) studied Acute Myocardial Infarction (n=385). Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway (NASP) vs. No implementation of NASP was evaluated on Incremental cost-effectiveness ratio (ICER) (ICER Dominant). Implementing the NASP clinical pathway was dominant compared to no implementation, yielding an incremental gain of 0.058 QALYs and expected cost savings of JPY 59,507 per person.

synapsesocial.com/papers/69cd7a095652765b073a6de9 https://doi.org/10.1536/ihj.25-323

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Cost-Effectiveness Analysis of Implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

Cost-Effectiveness Analysis of Implementing the Nagasaki Acute Myocardial Infarction Secondary Prevention Clinical Pathway

Key Points

Structured PICO

Main Result

Limitations

Discussion

Implication

Abstract

Cite This Study

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