title: Cost and quality of life: thrombolysis and primary angioplasty.
abstract: In an era of limited health care resources, analyses of the cost-effectiveness of cardiac interventions are becoming increasingly important. By generally accepted cost-effectiveness methodologies, the incremental cost for thrombolysis with streptokinase in patients with acute myocardial infarction ranges from approximately $3,500 to approximately $21,000/year of life saved. The estimated incremental cost-effectiveness of tissue-type plasminogen activator (t-PA) compared with streptokinase ranges from approximately $16,000 to $60,000/year of life saved. Pooled results of three randomized trials suggest that primary angioplasty can reduce mortality by as much as 63% without any increase in cost. This potential benefit is substantially greater than the 10% to 15% relative mortality rate reduction for each hour earlier that thrombolytic therapy is administered or the 12% relative benefit suggested for accelerated t-PA compared with that for streptokinase. Large-scale randomized trials are encouraged to determine whether the cost and mortality of population-based strategies using primary angioplasty are better than strategies that rely on intravenous thrombolysis.
authors.affiliation: Department of Medicine, University of California-San Francisco School of Medicine 94143, USA.
authors.forename: L
authors.initials: L
authors.lastname: Goldman
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006801:Humans; D009203:Myocardial Infarction / Q000191:economics / Q000534:rehabilitation / Q000628:therapy*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D013300:Streptokinase / Q000191:economics / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000191:economics*; D010959:Tissue Plasminogen Activator / Q000191:economics / Q000627:therapeutic use
chemical_list: D013300:Streptokinase; D010959:Tissue Plasminogen Activator