The cost effectiveness of primary angioplasty compared to thrombolysis in the real world: one year results from West London.
OBJECTIVE
The aim of this study is to use real-world data from West London to compare the cost-effectiveness of a contemporary primary angioplasty (PPCI) service to thrombolysis which it superseded over a time horizon of one year. Previous studies have depended on randomised trials and economic modelling.


RESULTS
Resource and outcome data were collected on 400 consecutive patients treated for ST segment elevation myocardial infarction (STEMI) at the hub and two spoke sites over three years. After the first 200 received thrombolysis, the PPCI service was introduced providing treatment for the next 200 cases. The incidence of major adverse cardiac events was significantly less in the PPCI group at 30 days (46.2% versus 7.0%, adjusted odds ratio (AOR) 12 p<0.001) and one year (57.4% versus 13.2%, AOR 8.6 p<0.001) driven by reductions in mortality and ischaemia driven revascularisations. Mean index and one year cumulative costs did not differ significantly between thrombolysis and PPCI (£7,016 versus £6,802; p=0.653 and £8442 versus £7,731; p=0.213 respectively). Initial angioplasty costs were significantly higher in the PPCI group offset by reduced hospital stay (8.5 versus 4 days; p<0.001).


CONCLUSIONS
This model of PPCI delivery is associated with larger than expected benefits and is cost-neutral when compared to thrombolysis.
Lancashire Cardiac Center, Blackpool Victoria Hospital, United Kingdom.
Kenneth P
KP
Morgan
Marie G
MG
Leahy
Jeremy N
JN
Butts
Kevin J
KJ
Beatt
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000191:economics*; D003362:Cost-Benefit Analysis; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000191:economics*