PCV30: COST-EFFECTIVENESS MODEL OF THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL INFARCTION

Abstract

OBJECTIVE: To conduct a cost-effectiveness analysis of tissue-Plasminogen Activator (t-PA) versus Streptokinase (SK) for treating acute myocardial infarction (AMI). PERSPECTIVE: Societal. DATA SOURCES: The cost, clinical outcomes and utilities were obtained from literature. METHODS: Decision analytical model was used to evaluate the short and long-term outcomes and costs associated with the use of SK or t-PA for AMI. Clinical benefit is expressed as Quality Adjusted Life Years (QALY) resulting from the treatment. Patients presenting within six hours after onset of symptoms, with a certain probability of death may be treated with SK or t-PA. Survivors may either get a disabling stroke or no stroke, patients with no disabling stroke may or may not have a reinfarction. Inpatient and long-term costs of coronary disease and disabling stroke were included. Costs and QALYs were discounted at 3%. Expected costs and QALYs yielded the Incremental Cost-effectiveness Ratio (ICER). Sensitivity analyses were performed on important factors. OUTCOMES: QALY which incorporated 30 days mortality, impacts of disabling stroke, reinfarction. Short-term and long-term medical costs. RESULTS: Using 30-day mortality data from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial, the baseline analysis yielded an ICER for t-PA of $24,882/QALY compared to SK. The ICER was sensitive to the difference in reinfarction rate (baseline 3.83%: 3% ICER $19,326: 6% ICER $120,767) and mortality rate (baseline 6.3%: 6.7% ICER $46,688: 7.2% ICER $197,850) of t-PA. CONCLUSION: t-PA is a cost-effective therapy for MI compared to SK. In addition, despite using costs and utilities from varied sources, and employing a simpler model the findings support previously published results.