Pitfalls in the economic evaluation of thrombolysis in myocardial infarction : The impact of national differences in the cost of thrombolytics and of differences in the efficacy across patient subgroups.
Background The economic evaluation of the results of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Artery (GUSTO) trial found that recombinant tissue plasminogen activator is more cost-effective than streptokinase for the treatment of acute myocardial infarction.
Aim We evaluated the impact on a cost effectiveness analysis, of the differences in the cost of thrombolytics among countries and of differences in efficacy across patient subgroups.
Methods We considered the crude costs of streptokinase and recombinant tissue plasminogen activator in Germany, Italy, the United Kingdom, and the United States of America, and the 30-day mortality found in the GUSTO trial.
We calculated the incremental costs for each life saved when streptokinase is substituted by recombinant tissue plasminogen activator.
We also calculated the incremental costs for each life saved for two protocols implying a selective use of streptokinase and recombinant tissue plasminogen activator (age-selective protocol : recombinant tissue plasminogen activator in patients<75 years, streptokinase in older patients ; site-selective protocol : recombinant tissue plasminogen activator in anterior acute myocardial infarction, streptokinase in non-anterior acute myocardial infarction). (...)
Mots-clés Pascal : Infarctus, Myocarde, Homme, Streptokinase, t-Plasminogen activator, Serine endopeptidases, Peptidases, Hydrolases, Enzyme, Chimiothérapie, Traitement, Economie santé, Coût, Etude comparative, Efficacité traitement, Etats Unis, Amérique du Nord, Amérique, Italie, Europe, Allemagne, Royaume Uni, Méthode analyse, Exploration, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie, Fibrinolytique
Mots-clés Pascal anglais : Infarct, Myocardium, Human, Streptokinase, t-Plasminogen activator, Serine endopeptidases, Peptidases, Hydrolases, Enzyme, Chemotherapy, Treatment, Health economy, Costs, Comparative study, Treatment efficiency, United States, North America, America, Italy, Europe, Germany, United Kingdom, Analysis method, Exploration, Cardiovascular disease, Coronary heart disease, Myocardial disease, Fibrinolytic
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0491222
Code Inist : 002B02G. Création : 19/02/1999.