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The Costs and Benefits of Community Thrombolysis for Acute Myocardial Infarction

A Decision-Analytic Model

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Abstract

Background: There is evidence that the earlier a patient reaches hospital and receives thrombolysis, the better the outcome. The GREAT (Grampian Region Early Anistreplase Trial) directly addressed the issue of early thrombolysis by evaluating, in a randomised controlled trial, the efficacy of thrombolysis in the community compared with that administered in hospital.

Objective: This paper aimed to model the cost and benefits of community compared with hospital thrombolysis from the UK NHS perspective, using efficacy data from the GREAT.

Methods: A decision-analytic approach was used to model these two alternatives. Resource use and cost estimates were estimated for a single tertiary centre. Estimates of effectiveness in life-years were obtained from the 4-year follow-up for patients recruited to the GREAT, using declining exponential approximation of life expectancy. Costs are in £, 2000/1 values.

Results: Community thrombolysis had an average life expectancy of 12.48 years and hospital thrombolysis had an average life expectancy of 12.39 years. Costs were £361 for community thrombolysis and £300 for hospital thrombolysis. Community thrombolysis led to an additional 0.09 years of life-expectancy gained compared with hospital thrombolysis at an additional cost of £61 per patient. Therefore, the incremental cost per life-year gained for the community thrombolysis service over the hospital thrombolysis service was £667. Sensitivity analysis showed that estimates of cost per life-year gained were most sensitive to the estimates of survival.

Conclusions: This model suggests that, from the UK NHS perspective, implementing community thrombolysis may lead to extra survival but at extra cost over hospital thrombolysis. Although the incremental cost per life-year is modest, judgements still have to be made, however, as to whether the extra benefits estimated are worth the additional resources required. This requires consideration of the local context in which the service may be introduced.

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Acknowledgements

We would like to thank John Rawles for his advice and for making the Grampian Region Early Anistreplase Trial (GREAT) data available. The Health Economics Research Unit is funded by the Chief Scientist Office of the Scottish Executive Health Department. Harvey Steffens was funded by the New Zealand Ministry of Health. Cam Donaldson holds the Health Foundation Chair in Health Economics, University of Newcastle. The views expressed here are those of the authors, not necessarily those of the funding bodies.

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Authors and Affiliations

  1. Health Economics Research Unit, Polwarth Building, University of Aberdeen, Foresterhill, Aberdeen, AB25 2ZD, Scotland

    Luke Vale, Harvey Steffens & Cam Donaldson

  2. New Zealand Ministry of Health, Wellington, New Zealand

    Harvey Steffens

  3. School of Population and Health Sciences and Business Health, University of Newcastle, Newcastle, England

    Cam Donaldson

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  1. Luke Vale
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  2. Harvey Steffens
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  3. Cam Donaldson
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Correspondence to Luke Vale.

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Vale, L., Steffens, H. & Donaldson, C. The Costs and Benefits of Community Thrombolysis for Acute Myocardial Infarction. PharmacoEconomics 22, 943–954 (2004). https://doi.org/10.2165/00019053-200422140-00004

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