Myocardial infarction: streptokinase was cost effective.

The study

• Viewpoint: hospital
• Benefit assessment: cost per life year saved
• Resources and costs: Data from the GISSI and ISIS-2 trials were used to estimate mortality, stroke and other complications. The cost of administering streptokinase at the general hospital was $200 per patient. The costs of treatment for bleeding complications included the hospital costs for a transfusion of two units of packed red cells at the hospital and the cost of two additional days in the cardiac care unit- approximately $1, 600. On the basis of informal information from a rehabilitation hospital, the cost of caring for a patient with a severe neurological deficit was estimated to be $200, 000 per year. Average annual medical costs related to coronary heart disease after infarction were estimated at $2, 100 per year. Medical costs unrelated to coronary heart disease were considered to be $4, 400 annually. The cost of a reinfarction attributable to thrombolysis was estimated to be $10, 000. Life expectancy after MI was calculated with the use of Coronary Heart Disease Policy Model as 5.5 years for a 70 year old and 2.7 years for an 80 year old. Costs were expressed as 1990 dollars and were discounted at 5% per year.
• Sensitivity analysis: Cost of thrombolytic therapy ($100-$2, 000), cost of bleeding complication ($2, 400 to $16,00; baseline $1, 600), rate of bleeding complications (3% to 25%; baseline 0.3%), cost of care for a stroke ($300, 000 to $1, 000, 000; baseline $200, 000), overall rate of stroke (2% to 6%; baseline 1.3%), in-hospital mortality and total medical care costs were altered.

The evidence

intervention	cost
streptokinase in a 70 year old	$21, 600 ( per year of life saved )
streptokinase in a 75 year old	$22, 400 ( per year of life saved )
streptokinase in an 80 year old patient	$21, 200 ( per year of life saved )


Effect of sensitivity analysis: the sensitivity analyses only had an effect at the extremes.
• Cost-effectiveness of streptokinase was compared with no thrombolysis.

Comments

1. The informal nature of cost, and lack of account for utility issues, makes for less reliability in this analysis.
2. The clinical data is taken from two large trials. A newer analysis may use larger trials or meta-analyses of thrombolytic treatment and provide different answers.



Citation

1. Krumholz HM, Pasternak RC, Weinstein MC, et al: Cost effectiveness of thrombolytic therapy with streptokinase in elderly patients with suspected acute myocardial infarction. New England Journal of Medicine 1992; 327 (1): 7-13
Contributor: Clare Wotton and Bob Phillips, February 2000
Reviewer:

_{Clinical Question.}

Patient	elderly patients with myocardial infarction
Intervention or Exposure	streptokinase
Comparison	no thrombolysis
Outcome	cost-effectiveness