title: Health and cost consequences of early versus late invasive strategy after thrombolysis for acute myocardial infarction.
abstract: The NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction showed an improved clinical outcome with early transfer for percutaneous coronary intervention (PCI) compared to a more conservative approach after thrombolysis. The aim of this substudy was to compare the 12-month quality-adjusted life years (QALYs) and costs of these alternative strategies.
  
  
  METHODS
  Patients with ST-elevation myocardial infarction <6 h duration and >90 min expected delay to PCI, received full-dose tenecteplase and were randomized to either early or late invasive strategy (n = 266). Detailed quality of life and resource use data were registered prospectively for a period of 12 months. Health outcomes were measured as quality of life using a generic instrument (15D). Quality of life scores were translated into QALYs. Unit costs were based on hospital accounts, fee schedules, and market prices.
  
  
  RESULTS
  After 12 months of follow-up, patients in the early invasive group had 0.008 (95% CI -0.027 to 0.043) more QALYs compared to the late invasive group. The mean total costs were €18,201 in the early versus €17,643 in the late invasive group, with a mean difference of €558 (95% CI -2258 to 3484). Cost/QALY was €69,750 while cost/avoided clinical endpoint was €5636.
  
  
  CONCLUSIONS
  Early and late invasive strategies after thrombolysis resulted in similar quality of life and similar costs in ST-elevation myocardial infarction patients living far from a PCI centre (NCT00161005).
authors: Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway. ellen.bohmer@sykehuset-innlandet.no
authors: Ellen
authors: E
authors: Bøhmer
authors: Ivar Sønbø
authors: IS
authors: Kristiansen
authors: Harald
authors: H
authors: Arnesen
authors: Sigrun
authors: S
authors: Halvorsen
mesh_terms: D000368:Aged; D000552:Ambulances / Q000191:economics; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D004632:Emergency Medical Services / Q000191:economics*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000191:economics; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D009664:Norway; D011446:Prospective Studies; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012111:Residence Characteristics; D019035:Rural Health Services / Q000191:economics*; D011795:Surveys and Questionnaires; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000191:economics; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase