Myocardial infarction: thrombolytic therapy was cost-effective.

Clinical bottom line (level 1b)

In patients who had a myocardial infarction, thrombolytic therapy was cost-effective compared with no thrombolytic therapy ($14, 438 per life year saved).
In patients treated within 6 hours of MI onset, thrombolytic therapy cost $11, 788 per life year saved.

Castillo et al: Annals of Pharmacotherapy 1997; 31: 596-603

Expires March 2003

The study

decision model
Setting: USA

Data was from a recent study of nine randomised, controlled trials and 12 month outcome data from a recently published meta-analysis of thrombolytic therapy trial data.

Viewpoint: societal
Benefit assessment: Survival to hospital discharge and survival to one year.
Resources and costs: The annual cost of thrombolytic therapy was $2045 per patient- this represents a weighted average (70% alteplase and 30% streptokinase) based on approximate market share. The cost of a bleeding incident ($1899 per patient), reinfarction ($11, 870 per patient) and 12 months of general medical care received in addition to other care included in the model ($7, 750 per one year survival) were derived from a study by Krumholz et al. Hospital physician costs associated with strokes treated in the hospital ($16, 085) were derived from the GUSTO trial, as was the estimated postdischarge cost for a stroke patient with sequale at one year ($48, 630). Cost of cardiac catheterisation was based on a study by Nicod et al ($2320 per catheterisation), and it was assumed that 91% of thrombolytic therapy patients and 43% of controls received the procedure. Costs were reported as 1995 dollars.
Sensitivity analysis: Time to treatment: 0-6 hours; 7-12 hours; 13-24 hours. Exclusive use of alteplase or streptokinase, and angina after infarction.

The evidence

intervention	cost
marginal cost of thrombolytic therapy	$14, 438 ( per life year saved )
for patients treated within 6 hours of MI, marginal cost of thrombolytic therapy	$11, 788 ( per life year saved )

Effect of sensitivity analysis: Time to treatment affected the cost-effectiveness- the longer the time to treatment, the greater the cost.

Comments

The patients in the Krumholz et al study were aged 75 years and older, which my bias the costs.

Citation

Castillo PA, Palmer CS, Halpern MT, et al: Cost-effectiveness of thrombolytic therapy for acute myocardial infarction. Annals of Pharmacotherapy 1997; 31: 596-603

Contributor: Clare Wotton and Chris Ball, February 2000
Reviewer:

_{Clinical Question.}

_Patient	_{myocardial infarction}
_{Intervention or Exposure}	_{thrombolytic therapy}
_Comparison	_{no thrombolytic therapy}
_Outcome	_{cost-effectiveness}