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A cost-effectiveness model for coronary thrombolysis/reperfusion therapy
G L Laffel1, H V Fineberg, E Braunwald
1Department of Medicine, Harvard Medical School, Boston, Massachusetts.
Journal of the American College of Cardiology
|November 1, 1987
Summary
Coronary thrombolysis/reperfusion therapy costs vary significantly based on infarct size, treatment timing, and reocclusion strategy. Intravenous thrombolytic agents are more cost-effective than intracoronary methods or angioplasty.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Interventional Cardiology
Background:
- Coronary thrombolysis/reperfusion therapy is a critical treatment for acute myocardial infarction.
- Evaluating the cost-effectiveness of different therapeutic strategies is essential for resource allocation.
Purpose of the Study:
- To model the incremental costs and benefits of various coronary thrombolysis/reperfusion strategies.
- To identify key variables influencing the cost per additional survivor.
Main Methods:
- Development of a cost-effectiveness model for coronary thrombolysis/reperfusion.
- Inclusion of intravenous and intracoronary streptokinase, intravenous tissue plasminogen activator, and primary angioplasty.
- Comparison of three reocclusion management strategies.
Main Results:
- Costs per additional survivor varied 2- to 15-fold based on myocardium at risk, treatment delay, reperfusion time, and reocclusion strategy.
- Intravenous thrombolytic strategies were consistently more cost-effective than intracoronary or primary angioplasty.
- Costs of $7,000-$100,000/additional survivor were achieved with optimal intravenous protocols for large/moderate infarcts.
Conclusions:
- Patient selection and treatment strategy are crucial for cost-effective thrombolysis/reperfusion.
- Routine use in small infarcts or bypass surgery for reocclusion increases costs significantly.
- Societal willingness to pay for incremental benefits should guide treatment decisions.