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6 PHARMACOECONOMICS
Cost effectiveness of thrombolytics in MI: national differences
Cost-effectiveness ratios associated with aJteplase [tPA I versus streptoki nase in acute myocardial infarction (MI) vary greatly between countries because of considerable drug cost differences, report investigators from Italy and the ex.
They used the economic evaluation of the results of the GCSTO trial* to examine the impact of drug cost differences** on the cost effectiveness of alteplase versus streptokinase in Germany, Italy, the UK and the US.
The costs for each extra life saved with the use of aJteplase, compared with streptokinase, for all patients involved in the GUSTO trial were SUS 147 402 in Germany, SUS 163 517 in Italy, SUS 112 344 in the UK and SCS221 053 in the es (1997 values).
Subgroup analysis showed that for patients with anterior acute MI, the incremental cost-effectiveness ratios for alteplase were considerably lower, whereas these ratios were highest for patients with nonanterior
acute MI. Applying a site-selective protocol (whereby only patients with anterior acute MI receive alteplase) would save 8 patients per 1000 treated, and the costs for each extra life saved would be SUS71 858 in Germany, SCS79 715 in Italy, SeS54 769 in the UK and SUS I 07 764 in the CS.
Selective use more cost effective The investigators conclude that selective use of
alteplase for the treatment of patients with certain types of MI is more cost effective than exclusive use. The investigators also point out that this study demonstrates the 'poor Reneralizahility of results of most economic evaluations'.
* See lnphanna RR6: 3, R May 1993: 800197201 [GUSTO = Global Utili:::Jl1ioll of Streptokinase alld tmfor Occluded Coronary Arteries J
** The costsjhr lOOmg ofalleplase in Germany; Italy; the UK and the US ill 1997 Wen? DM3(J1.)3.50. U048.60. 050 and $US2750, respectil'el\: The costs for 1.5 million units of streptokinase were DM470.50, 1201.20, £80.50 and $US537.30, respectivel.':
Lorenzon! R. Pagano D. Mazzotta G. Rosen SD. Fattorc G. ct al. Pitfall, In the
economIC evaluatlon of thromb()ly~l\ in myocardial infarction: the Impact of
natIonal diffcrcncc~ in the co~t of thrombolytic~ and of diffcrcncc~ In the cfficac}
aero» paucnt ,ubgroup'. European Hem Journal 19: 1518-1524. Oct 1 'i'i~
Inpharma~ 19 Dec 1998 No. 1168 1173-8324/98/1168-0006/501.00° Adis International Limited 1998. All rights reserved
