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An economic evaluation of thrombolysis in a remote rural community
Objectives:
To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis.
Design:
Economic evaluation based on the results of the Grampian region early anistreplase trial.
Setting:
29 rural general practices and one secondary care provider in Grampian, Scotland.
Subjects:
311 patients recruited to the Grampian region early anistreplase trial.
Interventions:
Intravenous anistreplase given either by general practitioners or secondary care clinicians.
Main Outcome Measures:
Survival at 4 years and costs of administration of thrombolysis.
Results:
Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of 425 pounds per patient. This gives a marginal cost of life saved at 4 years of 3,890 pounds (1,990 pounds to 42,820 pounds).
Conclusions:
The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.