Economic evidence of interventions for acute myocardial infarction: a review of the literature.
OBJECTIVE
The aims of this review are to identify and evaluate studies exploring the cost-effectiveness of primary angioplasty (PPCI) vs. thrombolysis (TL) for treating acute myocardial infarction (AMI).


RESULTS
A comprehensive free-text searching identified economic evaluation studies that were reviewed with respect to their effectiveness data, identification, measurement and valuation of resource data, measurement and valuation of health outcomes (clinical and QALYs) and uncertainty analysis. A total of 14 studies were included in the review: seven were economic evaluations alongside RCTs, two community-based studies or registries and five decision-analytical models. PPCI was found to be cost-effective when compared with TL in eight studies, cost-saving in three, cost-neutral in one, and not significantly different in terms of both cost and benefits in two studies.


CONCLUSIONS
The cost-effective evidence available is mainly derived from RCTs with stringent inclusion criteria using established catheter laboratories for providing PPCI treatment; these two components might restrict the generalisability of their "for managing patients with STEMI in hospital" settings. In order to aid policy makers on the real costs and benefits of the PPCI and TL, it is necessary to conduct more analyses with data from the real world in which there are more strategies evaluated for delivering PPCI than merely those in established catheter laboratories.
Centre for Research on Health and Social Care Management (CERGAS), Department of Policy Analysis and Public Management, Bocconi University, Milan, Italy.
Giuditta
G
Callea
Rosanna
R
Tarricone
Antonieta Medina
AM
Lara
D015906:Angioplasty, Balloon, Coronary / Q000191:economics* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis; D017048:Health Care Costs; D006295:Health Resources / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000191:economics* / Q000628:therapy*; D019057:Quality-Adjusted Life Years; D015912:Thrombolytic Therapy / Q000191:economics* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome