[Socioeconomic implications of the practice of thrombolysis in the acute stage of myocardial infarction].
The use of variegated and costly thrombolytic agents for the treatment of myocardial infarction in its acute phase may have medico-social advantages. In the present study, these advantages were evaluated after one year from two age and sex matched populations: 40 patients who underwent thrombolysis and 38 patients who did not. Compared with the first hospitalizations, the difference was + 4,000 francs, rising to + 11.000 francs with the drug Eminase. A questionnaire including medical, social and economic data was sent to the 78 patients and was filled by 63 of them, remaining unanswered by one patient who had thrombolysis and 10 patients who did not. Readmission to hospital showed a 44.000 francs difference to the benefit of patients who underwent thrombolysis. Ancillary care and return to work were similar in both groups. Cost expectancy was 119.500 francs for patients who had thrombolysis and 122.000 francs for those who did not. Thrombolysis therefore is a cost reduction factor, but its influence on costs is less pronounced when it is performed soon after the onset of myocardial infarction. Thrombolysis is more expensive when carried out at home than in hospital. In this study, the excess cost (+ 5.000 francs) was due to the relatively small number of patients and to the loss of professional activity which may be an uncertain factor. Mortality at one year was nil when thrombolysis was performed within the first two hours (12 patients) and rose to 16.6 percent between 2 and 3 hours (18 patients) and 30 percent after 3 hours (10 patients). Conducted on a necessarily limited number of patients, this multiple criteria study was also aimed at establishing a method to evaluate the health expenditures imposed by the introduction of new and costly treatment in the management of myocardial infarction.
Herve
C
C
UFR de médecine, hôpital Henri-Mondor, Créteil.
Castiel
D
D
Gaillard
M
M
Daussac
C
C
Leroux
V
V
Jan
F
F
Castaigne
A
A
D000328:Adult; D000368:Aged; D016255:Anistreplase; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D004341:Drug Evaluation; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics / Q000401:mortality; D010958:Plasminogen / Q000627:therapeutic use*; D011897:Random Allocation; D013300:Streptokinase / Q000627:therapeutic use*; D026712:Value of Life
D005343:Fibrinolytic Agents; D016255:Anistreplase; D010958:Plasminogen; D013300:Streptokinase
Implications socio-économiques de la pratique de la thrombolyse à la phase aiguë de l'infarctus du myocarde.