An economic evaluation of thrombolysis in a remote rural community.
OBJECTIVE
To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis.


METHODS
Economic evaluation based on the results of the Grampian region early anistreplase trial.


METHODS
29 rural general practices and one secondary care provider in Grampian, Scotland.


METHODS
311 patients recruited to the Grampian region early anistreplase trial.


METHODS
Intravenous anistreplase given either by general practitioners or secondary care clinicians.


METHODS
Survival at 4 years and costs of administration of thrombolysis.


RESULTS
Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of 425 pounds per patient. This gives a marginal cost of life saved at 4 years of 3,890 pounds (1,990 pounds to 42,820 pounds).


CONCLUSIONS
The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.
Vale
L
L
Health Economics Research Unit, University of Aberdeen.
Silcock
J
J
Rawles
J
J
D016255:Anistreplase / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005194:Family Practice / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006792:House Calls; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000191:economics; D012423:Rural Health; D012606:Scotland; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000191:economics*; D026712:Value of Life
D016255:Anistreplase