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Cost-effectiveness of thrombolytic therapy for acute myocardial infarction
P A Castillo1, C S Palmer, M T Halpern
1Battelle Centers for Public Health Research and Evaluation, Arlington, VA, USA.
Insights
Thrombolytic therapy for acute myocardial infarction is cost-effective, especially when administered within 6 hours. Early treatment significantly improves outcomes and saves lives, making it a valuable cardiovascular intervention.
Area of Science:
- Cardiovascular Medicine
- Health Economics
- Clinical Trial Analysis
Background:
- Acute myocardial infarction (AMI) necessitates timely and effective treatment to improve patient survival and reduce long-term morbidity.
- Thrombolytic therapy has emerged as a critical intervention for AMI, but its cost-effectiveness requires careful evaluation, particularly concerning treatment delays.
Purpose of the Study:
- To evaluate the cost-effectiveness of thrombolytic therapy compared to standard non-thrombolytic care for patients experiencing acute myocardial infarction.
- To specifically assess how the time to treatment influences the cost-effectiveness of thrombolytic therapy.
Main Methods:
- A decision model was constructed to analyze benefits, risks, and costs of thrombolytic therapy versus standard care for AMI.
- Pooled data from nine randomized controlled trials and meta-analysis of 12-month outcomes were utilized.
- Cost-effectiveness was measured by marginal cost per death averted and cost per year of life saved, with sensitivity analyses on treatment time and drug cost.
Main Results:
- The overall marginal cost for thrombolytic therapy was $222,344 per death averted at 1 year, equating to $14,438 per year of life saved.
- For patients treated within 6 hours of AMI, the marginal cost per death averted decreased to $181,536 at 1 year, or $11,788 per year of life saved.
Conclusions:
- Thrombolytic therapy demonstrates significant cost-effectiveness compared to other cardiovascular interventions and medical therapies.
- Reducing the time to treatment for acute myocardial infarction is crucial for maximizing the cost-effectiveness of thrombolytic therapy.
Objective:
To estimate the cost-effectiveness of thrombolytic therapy versus no thrombolytic therapy for patients following acute myocardial infarction, focusing on the impact of time to treatment on outcome.
Methods:
A decision model was developed to assess the benefits, risks, and costs associated with thrombolytic therapy for treatment of acute myocardial infarction compared with standard nonthrombolytic therapy. The model used pooled data from a recent study of nine large randomized, controlled clinical trials and 12-month outcome data from a recently published meta-analysis of thrombolytic therapy trial data. Outcomes were expressed in terms of survival to hospital discharge and survival to 1 year after discharge. The risks of treatment that led to death, morbidity, or added costs were estimated. The model determined excess and marginal costs per death averted to hospital discharge and at 1 year. Results were also estimated in terms of cost per year of life saved. Sensitivity analyses included variations in time to treatment and drug cost.
Results:
The marginal cost of thrombolytic therapy per death averted at 1 year was $222,344, or $14,438 per year of life saved. For patients treated within 6 hours of acute myocardial infarction, the marginal cost per death averted was $181,536 at 1 year, or $11,788 per year of life saved.
Conclusions:
Thrombolytic therapy is significantly more cost-effective than many other cardiovascular interventions and compares favorably with other forms of medical therapy. Results suggest that shortening the time to treatment has a critical impact on the cost-effectiveness of thrombolytic therapy.