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Updated: May 3, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 27, 2013
Cost-effectiveness of thrombolysis--a randomized study of intravenous rt-PA in suspected myocardial infarction
Insights
Intravenous thrombolytic therapy (rt-PA) for myocardial infarction increases first-year costs but offers significant long-term value. This treatment improves life expectancy and quality of life, proving cost-effective overall.
Area of Science:
- Cardiology
- Health Economics
- Pharmacoeconomics
Background:
- Myocardial infarction (MI) poses a significant health and economic burden.
- Intravenous thrombolytic therapy, specifically recombinant tissue plasminogen activator (rt-PA), is a critical treatment for acute MI.
- Understanding the long-term cost-effectiveness and quality-of-life impact of rt-PA is essential for clinical decision-making.
Purpose of the Study:
- To evaluate the economic costs associated with rt-PA therapy in the first year post-MI.
- To assess the impact of rt-PA on patients' quality of life (QoL).
- To determine the cost-effectiveness and cost-utility of rt-PA treatment.
Main Methods:
- A randomized, placebo-controlled trial involving patients with suspected MI.
- Cost analysis including direct healthcare expenditures and indirect costs (e.g., lost productivity).
- Quality of life assessment using the Nottingham Health Profile (NHP) and NYHA functional classification.
Main Results:
- rt-PA treatment resulted in higher direct costs but lower indirect costs in the first year.
- Total first-year costs were moderately higher in the rt-PA group (5680 SEK).
- rt-PA demonstrated a gain of 1.25 life years and showed no significant long-term negative impact on QoL, with improvements in sleep and energy dimensions after 12 months.
Conclusions:
- Intravenous thrombolysis with rt-PA is a cost-effective treatment for myocardial infarction.
- The therapy offers favorable cost-effectiveness and cost-utility ratios compared to other cardiac treatments.
- The long-term benefits in terms of life expectancy and quality of life justify the initial treatment costs.
Abstract:
The aim of this randomized placebo-controlled study is to ascertain the costs of intravenous thrombolytic therapy (rt-PA) in the first year after suspected myocardial infarction and to measure the treatment effect on quality of life. The main findings are that the direct costs (including all health care expenditure), on average were 9880 SEK higher in the rt-PA group (N = 153) than in the placebo group (N = 160). At the same time the indirect costs were 4200 SEK lower in the rt-PA group. The total cost of the first year after suspected myocardial infarction were on average 5680 SEK higher in the rt-PA group. The treatment gain in mean life expectancy calculated with a yearly mortality rate of 6% from the end of follow up was 1.25 years. Quality of life was measured using the Nottingham Health Profile and was classified according to NYHAs functional classification. The Nottingham Health Profile (NHP) results show that the rt-PA patients had a slightly higher (worse) score in all dimensions after one month with the exception of sleep. After 12 months the differences no longer exist and the rt-PA patients had even lower (better) scores in the sleep and energy dimensions. The calculated cost-effectiveness ratio varies from 3090 to 5970 SEK per life year saved and the calculated cost-utility ratio varies from 3260 SEK to 6310 SEK per QALY gained. In comparison with other heart disease treatments, intravenous thrombolysis is cost-effective.
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