Health and cost consequences of early versus late invasive strategy after thrombolysis for acute myocardial infarction

Eur J Cardiovasc Prev Rehabil. 2011 Oct;18(5):717-23. doi: 10.1177/1741826711398425. Epub 2011 Feb 18.

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.

Conclusion: 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).

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ambulances / economics
  • Angioplasty, Balloon, Coronary / adverse effects
  • Angioplasty, Balloon, Coronary / economics*
  • Angioplasty, Balloon, Coronary / mortality
  • Coronary Artery Bypass / adverse effects
  • Coronary Artery Bypass / economics*
  • Coronary Artery Bypass / mortality
  • Cost-Benefit Analysis
  • Drug Costs
  • Emergency Medical Services / economics*
  • Female
  • Fibrinolytic Agents / administration & dosage
  • Fibrinolytic Agents / economics
  • Health Care Costs*
  • Health Services Accessibility / economics
  • Hospital Costs
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / economics*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy*
  • Norway
  • Prospective Studies
  • Quality of Life
  • Quality-Adjusted Life Years
  • Residence Characteristics
  • Rural Health Services / economics*
  • Surveys and Questionnaires
  • Tenecteplase
  • Thrombolytic Therapy / adverse effects
  • Thrombolytic Therapy / economics*
  • Thrombolytic Therapy / mortality
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage
  • Tissue Plasminogen Activator / economics
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Tenecteplase

Associated data

  • ClinicalTrials.gov/NCT00161005