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Thrombolytic therapy in the elderly. Pharmacoeconomic considerations
K Ramanathan1, C J Ellis, H D White
1Cardiology Department, Green Lane Hospital, Auckland, New Zealand.
Drugs & Aging
|April 1, 1996
Summary
Elderly patients with acute myocardial infarction (MI) face the highest mortality risk. Alteplase therapy is cost-effective for older adults, offering survival benefits compared to older treatments.
Area of Science:
- Cardiology
- Health Economics
Background:
- Elderly patients (65+) have the highest mortality risk after acute myocardial infarction (MI).
- Thrombolytic therapy may offer significant benefits to this demographic.
- Previous analyses show varying cost-effectiveness for different thrombolytics.
Purpose of the Study:
- To evaluate the cost-effectiveness of alteplase compared to streptokinase for acute MI treatment.
- To determine if alteplase is a cost-effective intervention for elderly MI patients.
Main Methods:
- Cost-effectiveness analysis comparing alteplase and streptokinase.
- Inclusion of mortality data and quality-adjusted life-years (QALYs) in calculations.
- Stratification of analysis by age and MI type (anterior/inferior).
Main Results:
- Alteplase demonstrated improved survival rates compared to streptokinase (6.3% vs. 7.3% 30-day mortality).
- The cost per life-year saved with alteplase was $32,678, exceeding the $50,000 threshold in younger patients.
- For patients over 75, alteplase cost-effectiveness was favorable, particularly for anterior and inferior MIs ($13,410 and $16,246 per life-year saved, respectively).
Conclusions:
- Alteplase is a cost-effective treatment for acute myocardial infarction in elderly patients.
- The economic benefits of alteplase are most pronounced in older MI populations.
- Treatment decisions should consider age and MI characteristics for optimal resource allocation.