Is a target culture in health care always compatible with efficient use of resources? A cost-effectiveness analysis of an intervention to achieve thrombolysis targets.
BACKGROUND
The UK government has attempted to improve the quality of health care in the National Health Service and minimize geographical variations in quality by imposing targets in certain areas of health care. The measures taken by local health economies to achieve these targets have not before been subjected to cost-effectiveness analysis. We have assessed the cost effectiveness of an intervention designed to achieve thrombolysis time targets.


METHODS
In the setting of a single district general hospital in England, we audited local pain-to-needle (PTN) and door-to-needle (DTN) times, before and after a pounds 208,000 (Euro 310,000, dollar 370,000) annual expenditure to improve performance against government targets. The intervention included the recruitment of additional nursing time in the Accident & Emergency Department and the use of a single bolus thrombolytic agent for all patients with ST elevation myocardial infarction. An economic evaluation was performed, based on the expected number of additional lives saved, extrapolated from a meta-analysis of previous thrombolysis trials.


RESULTS
The intervention reduced mean DTN time from 37.6 +/- 5.9 minutes (mean +/- SEM) to 27.6 +/- 3.6 minutes (p = 0.06). The cost per life saved was pounds 3,423 +/- 850 (Euro 5,100,000, dollar 6,100,000), the cost per life year gained was pounds 222,184 (Euro 330,000, dollar 390,000) and the cost per quality-adjusted life year (QALY) gained was pounds 246,871 (Euro 370,000, dollar 440,000).


CONCLUSIONS
Although moderately successful at improving performance against government targets, this intervention to promote rapid thrombolysis proved to be an inefficient use of health-care resources. Strict government targets in health care may not always lead to efficient targeting of resources.
Singaroyan
Robin
R
Department of Cardiology, Macclesfield District General Hospital, Victoria Road, Macclesfield, Cheshire SK10 3BL, UK.
Seed
C Alison
CA
Egdell
Robin M
RM
D002391:Catchment Area, Health; D003362:Cost-Benefit Analysis; D017598:Efficiency, Organizational; D004739:England / Q000453:epidemiology; D005260:Female; D005843:Geography; D006302:Health Services Research; D006767:Hospitals, District / Q000191:economics / Q000592:standards*; D006769:Hospitals, General / Q000191:economics / Q000592:standards*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics / Q000592:standards*; D015912:Thrombolytic Therapy / Q000191:economics / Q000706:statistics & numerical data*; D013996:Time and Motion Studies