title: Is primary angioplasty cost effective in the UK? Results of a comprehensive decision analysis.
abstract: OBJECTIVE
  To assess the cost effectiveness of primary angioplasty, compared with medical management with thrombolytic drugs, to achieve reperfusion after acute myocardial infarction (AMI) from the perspective of the UK NHS.
  
  
  METHODS
  Bayesian evidence synthesis and decision analytic model.
  
  
  METHODS
  A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature.
  
  
  METHODS
  Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs).
  
  
  RESULTS
  For the base case, the incremental cost-effectiveness ratio of primary angioplasty was 9241 pounds sterling for each additional QALY, with a probability of being cost effective of 0.90 for a cost-effectiveness threshold of 20,000 pounds sterling. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty.
  
  
  CONCLUSIONS
  Primary angioplasty is cost effective for the treatment of AMI on the basis of threshold cost-effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length.
authors: Centre for Health Economics, University of York, York, UK.
authors: Yolanda
authors: Y
authors: Bravo Vergel
authors: Stephen
authors: S
authors: Palmer
authors: Christian
authors: C
authors: Asseburg
authors: Elisabeth
authors: E
authors: Fenwick
authors: Mark
authors: M
authors: de Belder
authors: Keith
authors: K
authors: Abrams
authors: Mark
authors: M
authors: Sculpher
mesh_terms: D017130:Angioplasty / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D006295:Health Resources / Q000191:economics; D006801:Humans; D007902:Length of Stay; D009203:Myocardial Infarction / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents
references: Pharmacoeconomics. 1998 Apr;13(4):397-409
references: 10178664
references: J Am Coll Cardiol. 1997 Dec;30(7):1741-50
references: 9385902
references: Wien Klin Wochenschr. 1999 Jan 15;111(1):37-41
references: 10067269
references: Circulation. 2005 Feb 15;111(6):761-7
references: 15699253
references: Health Technol Assess. 2005 May;9(17):1-99, iii-iv
references: 15876363
references: Eur Heart J. 2005 Dec;26(24):2733-41
references: 16311237
references: Heart. 2006 Jan;92(1):68-74
references: 15831599
references: Pharmacoeconomics. 2006;24(1):1-19
references: 16445299
references: Eur Heart J. 2006 Apr;27(7):779-88
references: 16513663
references: Eur Heart J. 2006 May;27(10):1146-52
references: 16624832
references: Heart. 2007 Oct;93(10):1244-50
references: 17277350
references: Arch Intern Med. 1998 Nov 23;158(21):2329-38
references: 9827784
references: Pharmacoeconomics. 1999 Nov;16(5 Pt 2):577-93
references: 10662482
references: BMJ. 2001 Dec 1;323(7324):1300-3
references: 11731399
references: Eur Heart J. 2002 Aug;23(16):1291-1300
references: 12175666
references: Lancet. 2002 Sep 14;360(9336):825-9
references: 12243916
references: Lancet. 2003 Jan 4;361(9351):13-20
references: 12517460
references: Pharmacoeconomics. 2003;21(3):191-200
references: 12558469
references: J Epidemiol Community Health. 2003 Aug;57(8):622-7
references: 12883071
references: Health Econ. 2004 Mar;13(3):203-26
references: 14981647
references: BMJ. 2004 May 22;328(7450):1254-6
references: 15155508
references: Lancet. 2004 Sep 18-24;364(9439):1045-53
references: 15380963
references: Br Heart J. 1992 Mar;67(3):255-62
references: 1554544
references: N Engl J Med. 1993 Nov 25;329(22):1615-22
references: 8232430
references: J Health Econ. 1993 Dec;12(4):459-67
references: 10131756
references: Lancet. 1996 Sep 21;348(9030):771-5
references: 8813982