Cost and quality of life: Thrombolysis and primary angioplasty

In an er of limited health care resources, analyses of the cost-effectiveness of cardiac interventions are becoming increasingly important. By generally accepted cost-effectiveness methodologies, the incremental cost for thrombolysis with streptokinase in patients with acute myocardial infarction ranges from not, vert, similar$3,500 to not, vert, similar$21,000/year of life saved. The estimated incremental cost-effectiveness of tissue-type plasminogen activator (t-PA) compared with streptokinase ranges from not, vert, similar$16,000 to $60,000/year of life saved. Pooled results of three randomized trials suggest that primary angioplasty can reduce mortality by as much as 63% without any increase in cost. This potential benefit is substantially greater than the 10% to 15% relative mortality rate reduction for each hour earlier that thrombolytic therapy is administered or the 12% relative benefit suggested for accelerated t-P compared with that for streptokinase. Large-scale randomized trials are encouraged to determine whether the cost and mortality of population-based strategies using primary angioplasty are better than strategies that rely on intravenous thrombolysis.