Cost-effectiveness of prehospital versus inhospital thrombolysis in acute myocardial infarction.
BACKGROUND
There is evidence that prehospital thrombolysis improves the outcome in ST-elevation myocardial infarction (STEMI).


OBJECTIVE
This study aimed at comparing the cost-effectiveness of prehospital compared to inhospital thrombolysis for STEMI from the National Health System perspective.


METHODS
A decision-analytic model was used to compare these two strategies. The study endpoint was life-years gained. Resource use and costs were estimated from the National Health System perspective. The Decision tree and Markov Model were constructed using the results of published clinical trials. Costs were expressed in Reais (R$), for the year 2005.


RESULTS
For a time horizon of 20 years, prehospital thrombolysis had an average life expectancy of 11.48 years and inhospital thrombolysis had an average life expectancy of 11.32 years. Costs were R$ 5,640 for prehospital thrombolysis and R$ 5,816 for inhospital thrombolysis. Inhospital thrombolysis led to an additional cost of R$ 176 per patient. Pre-hospital thrombolysis led to additional 0.15 years of life-expectancy gain compared with inhospital thrombolysis.


CONCLUSIONS
This model suggests that, from the National Health System perspective, implementing prehospital thrombolysis for ST-elevation myocardial infarction (STEMI) may lead to extra survival and fewer costs when compared to inhospital thrombolysis.
Araújo
Denizar Vianna
DV
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. denizar@cardiol.br
Tura
Bernardo Rangel
BR
Brasileiro
Antonio Luiz
AL
Luz Neto
Heitor
H
Pavão
Ana Luiza Braz
AL
Teich
Vanessa
V
D000208:Acute Disease; D001938:Brazil; D003663:Decision Trees; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008017:Life Expectancy; D009203:Myocardial Infarction / Q000191:economics / Q000628:therapy*; D009313:National Health Programs; D015912:Thrombolytic Therapy / Q000191:economics* / Q000379:methods; D013997:Time Factors