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[Cost efficacy analysis of thrombolytic strategies]
Insights
Comparing thrombolytic agents, streptokinase with aspirin is more cost-effective than recombinant tissue plasminogen activator (rt-PA) for acute myocardial infarction treatment. Aggressive reperfusion strategies significantly increase hospital costs for both agents.
Area of Science:
- Pharmacoeconomics of cardiovascular therapies.
- Health services research in acute myocardial infarction management.
Context:
- Thrombolytic agents and reperfusion strategies significantly influence hospital costs for acute myocardial infarction (AMI) treatment.
- Variability in treatment protocols impacts overall healthcare expenditure.
Purpose:
- To compare the cost-effectiveness of different thrombolytic strategies for AMI.
- To analyze the economic impact of varying reperfusion therapies on hospital costs.
Summary:
- Nine treatment strategies combining three thrombolytic preparations (streptokinase alone, streptokinase + aspirin, rt-PA) and three reocclusion management approaches were evaluated.
- Hospital costs were estimated using unit costs for cardiac catheterization, surgery, and daily hospitalization, based on literature and a 420-patient series.
- Streptokinase + aspirin with conservative management cost 22,500 FF per patient, increasing by 15% with delayed angioplasty and 45% with aggressive reperfusion.
Impact:
- Conservative rt-PA management was 37% more expensive than conservative streptokinase + aspirin.
- The cost per additional survivor was twenty times higher for rt-PA conservative strategy compared to streptokinase + aspirin.
- Findings highlight significant economic differences between thrombolytic agents and reperfusion strategies in AMI care.
Abstract:
Price disparities of thrombolytic agents and variability in complementary reperfusion therapies have a big impact on hospital costs of thrombolysis. Nine strategies combining 3 thrombolytic preparations (SK alone, SK + aspirin and rt-PA) and 3 strategies for the management of reocclusion are compared. Unit costs of cardiac catheterisation and surgery and direct cost of a hospital day were estimated from hospital accounts. The hypotheses concerning the frequency of interventions and length of stay were based on results in the literature and analysis of a series of 420 patients from 3 hospital centres. The average direct cost of hospitalisation per patient treated with streptokinase plus aspirin with a conservative approach was 22,500 FF. It increased by 15 p. 100 with delayed elective angioplasty and by 45 p. 100 with an aggressive reperfusion strategy. In a conservative protocol, hospital costs were 37 p. 100 higher when rt-PA was used instead of streptokinase. An rt-PA conservative management strategy was associated with a twenty times higher cost per additional survivor than that of streptokinase with aspirin.