title: Cost-effectiveness of prehospital versus inhospital thrombolysis in acute myocardial infarction.
abstract: 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.
authors.affiliation: Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil. denizar@cardiol.br
authors.forename: Denizar Vianna
authors.initials: DV
authors.lastname: Araújo
authors.forename: Bernardo Rangel
authors.initials: BR
authors.lastname: Tura
authors.forename: Antonio Luiz
authors.initials: AL
authors.lastname: Brasileiro
authors.forename: Heitor
authors.initials: H
authors.lastname: Luz Neto
authors.forename: Ana Luiza Braz
authors.initials: AL
authors.lastname: Pavão
authors.forename: Vanessa
authors.initials: V
authors.lastname: Teich
mesh_terms: 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