Analysis of the relative costs and effectiveness of primary angioplasty versus tissue-type plasminogen activator : The Primary Angioplasty in Myocardial Infarction (PAMI) Trial.
We sought to determine the relative cost and effectiveness of two different reperfusion modalities in patients with acute myocardial infarction (AMI).
Recent studies have found superior clinical outcomes after reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) compared with thrombolytic therapy.
The high up-front costs of cardiac catheterization may diminish the relative advantages of this invasive strategy.
Detailed in-hospital charge data were available from all 358 patients with AMI randomized to tissue-type plasminogen activator (t-PA) or primary PTCA in the United States from the Primary Angioplasty in Myocardial Infarction trial.
Resource consumption during late follow-up was estimated by assessment of major clinical events and functional status.
Compared with t-PA, primary PTCA resulted in reduced rates of in-hospital mortality (2.3% vs. 7.2%, p=0.03), reinfarction (2.8% vs. 7.2%, p=0.06), recurrent ischemia (11.3% vs. 28.7%, p<0.0001) and stroke (0% vs. 3.9%, p=0.02) and a shorter hospital stay (7.6 ± 3.3 days vs. 8.4 ± 4.7 days, p=0.04).
Despite the initial costs of cardiac catheterization in all patients with the invasive strategy, total mean (±SD) hospital charges were $3,436 lower per patient with PTCA than with t-PA ($23,468 ± $13,410 vs. $26,904 ± $18,246, p=0.04), primarily due to the reduction in adverse in-hospital outcomes. (...)
Mots-clés Pascal : Infarctus, Myocarde, Altéplase, Dilatation instrumentale, Artère coronaire, Analyse coût efficacité, Economie santé, Chimiothérapie, Traitement, Efficacité traitement, Technique, Homme, Etude comparative, Fibrinolytique, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Traitement instrumental
Mots-clés Pascal anglais : Infarct, Myocardium, Alteplase, Instrumental dilatation, Coronary artery, Cost efficiency analysis, Health economy, Chemotherapy, Treatment, Treatment efficiency, Technique, Human, Comparative study, Fibrinolytic, Cardiovascular disease, Coronary heart disease, Myocardial disease, Instrumentation therapy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 97-0251624
Code Inist : 002B12A03. Création : 11/06/1997.