[Cost efficacy analysis of thrombolytic strategies].
Price disparities of thrombolytic agents and variability in complementary reperfusion therapies have a big impact on hospital costs of thrombolysis. Nine strategies combining 3 thrombolytic preparations (SK alone, SK + aspirin and rt-PA) and 3 strategies for the management of reocclusion are compared. Unit costs of cardiac catheterisation and surgery and direct cost of a hospital day were estimated from hospital accounts. The hypotheses concerning the frequency of interventions and length of stay were based on results in the literature and analysis of a series of 420 patients from 3 hospital centres. The average direct cost of hospitalisation per patient treated with streptokinase plus aspirin with a conservative approach was 22,500 FF. It increased by 15 p. 100 with delayed elective angioplasty and by 45 p. 100 with an aggressive reperfusion strategy. In a conservative protocol, hospital costs were 37 p. 100 higher when rt-PA was used instead of streptokinase. An rt-PA conservative management strategy was associated with a twenty times higher cost per additional survivor than that of streptokinase with aspirin.
Launois
R
R
UFR médecine de Bobigny, laboratoire de santé publique, Bobigny.
Launois
B
B
D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D003663:Decision Trees; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D012008:Recurrence; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics* / Q000379:methods
D005343:Fibrinolytic Agents
Analyse coût-efficacité des stratégies thrombolytiques.