[Analysis of the medico-economic literature comparing primary angioplasty and thrombolysis in the management of acute myocardial infarction].
OBJECTIVE
To assess the generalizability of the medico-economic analysis comparing primary coronary angioplasty and thrombolytic therapy for acute myocardial infarction.


METHODS
A systematic analysis of published studies was performed by two independent reviewers, in accordance with guidelines promulgated by health economic experts.


RESULTS
Eleven articles, which concerned seven studies, were selected. Respectively, four evaluations were carried out in U.S. and three other in European countries (France, Netherland and Austria). There were three randomized trials, two observational studies and two decision trees. The costs were respectively ranged 2042 to 83,708 1999 US dollars for thrombolytic therapy and 3289 to 83,477 1999 US dollars for angioplasty. In two randomized trials and one decisional tree, the primary coronary angioplasty was both more effective and less costly than the thrombolysis therapy. One observational study concluded that thrombolytic therapy was less costly than primary angioplasty despite comparable effectiveness. Two analysis could not conclude of a difference between the alternatives, because of lack of statistical power.


CONCLUSIONS
Published medico-economic analysis remain of a little interest for the French health care system because of lack of transparency in presentation of results. The dominance of the primary angioplasty was sensitive to time required for patient's transfer (ideally less than an hour), to the presence of redundant laboratories in an area and to the presence of an experienced staff for 24 h a day.
Labarère
J
J
Laboratoire GPSP, faculté de médecine, 38700 La Tronche, France. JLabarere@chu-grenoble.fr
Bardin
C
C
Belle
L
L
François
P
P
D017130:Angioplasty / Q000191:economics*; D006801:Humans; D009203:Myocardial Infarction / Q000191:economics* / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000191:economics*