Document Detail


Primary angioplasty versus thrombolysis for acute ST-elevation myocardial infarction: an economic analysis of the National Infarct Angioplasty project.
MedLine Citation:
PMID:  19508972     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To estimate the cost-effectiveness of primary angioplasty compared with thrombolysis for acute ST elevation myocardial infarction. Design Cost analysis of UK observational database, incorporated into decision analytical model.
METHODS: Patients receiving treatment within a comprehensive angioplasty service were compared with control patients receiving thrombolysis-based care. The treatment costs and delays to treatment of thrombolysis and angioplasty were estimated. These estimates were then incorporated into an existing model of cost-effectiveness that synthesises evidence from 22 randomised trials to estimate health outcomes measured by quality-adjusted life years (QALYs). Main outcome measures Costs from a health service perspective and outcomes measured as quality adjusted.
RESULTS: The mean cost of the initial treatment was 3509 pounds for thrombolysis at control sites, 5176 pounds for angioplasty in usual working hours at National Infarct Angioplasty Project sites and an additional 245 pounds if undertaken out of hours. Angioplasty-based care had an incremental cost of 4520 pounds per QALY gained and 0.9 probability of being cost-effective at a threshold of 20,000 pounds per QALY gained. This probability was >0.95 if patients were directly admitted to the cardiac catheter laboratory, 0.75 if admitted via the emergency department or coronary care unit and 0.38 if transferred to the angioplasty centre from another hospital.
CONCLUSIONS: Overall, primary angioplasty-based care is highly likely to be cost-effective at an assumed threshold of 20,000 pounds per QALY gained. It is more likely to be cost-effective if patients are admitted directly to the cardiac catheter laboratory rather than via other hospital departments, or if transferred from another hospital.
Authors:
Allan Wailoo; Steve Goodacre; Fiona Sampson; Mónica Hernández Alava; Christian Asseburg; Stephen Palmer; Mark Sculpher; Keith Abrams; Mark de Belder; Huon Gray
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural     Date:  2009-06-08
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  96     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-28     Completed Date:  2010-06-08     Revised Date:  2011-01-03    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  668-72     Citation Subset:  AIM; IM    
Affiliation:
Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK. a.j.wailoo@sheffield.ac.uk
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MeSH Terms
Descriptor/Qualifier:
Angioplasty / economics*
Case-Control Studies
Cost-Benefit Analysis
Humans
Length of Stay
Middle Aged
Myocardial Infarction / economics,  therapy*
Quality-Adjusted Life Years
Thrombolytic Therapy / economics*
Treatment Outcome
Comments/Corrections
Comment In:
Heart. 2011 Jan;97(2):163; author reply 163   [PMID:  20962347 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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