Cost implications of prehospital thrombolysis for acute MI

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<ul><li><p>CURRENT ISSUES</p><p>Cost implications of prehospitalthrombolysis for acute MI</p><p>Rapid prehospital administration of economicalthrombolytic agents for the treatment of acutemyocardial infarction (MI) appears to offer advantagesover hospital administration of more costly thrombo-lytics, even in urban areas, according to Dr StuartBarton and Professor Tom Walley from the Universityof Liverpool, UK.</p><p>Low incremental cost?In the UK, the relevant incremental cost of</p><p>providing 2600 prehospital courses of thrombolyticsfor 6500 chest pain emergencies in a population of1 million people is around 250 OOO/year (109 pertreated patient with MI). This cost is low becausedelivery of thrombolytics is provided as part of theroutine emergency service that is already provided byparamedics or primary-care physicians.</p><p>The incremental cost of prehospital administration ofstreptokinase, including organisational costs, is aroundIl8/patient, compared with hospital administration ofthe drug. In contrast, the incremental cost of prehospitaladministration of anistreplase is 5811patient, comparedwith inhospital administration of streptokinase.</p><p>Depends on time saved by early useCost-effectiveness values depend on the amount of</p><p>time saved by prehospital administration, say Dr Bartonand Professor Walley. They believe that the 'cost benefit'is only apparent when the decrease in delay producedby hospital administration is &gt; 150 minutes andstreptokinase is the thrombolytic agent used. At a timesaving of only 20 minutes, the incremental costeffectiveness of prehospital thrombolysis is around10 OOO/additionallife saved.</p><p>Organisational costs generally account for most ofthe additional expenses associated with prehospitalthrombolytic drug administration, and the drugs billcan increase by about 10%. However, about 50% ofthese increased costs of prehospital administration areoffset by a reduction in the need for hospital beds.</p><p>Dr Barton and Professor Walley believe that thereis a need for more cost effective and more easilyadministered thrombolytic regimens and for a clearerunderstanding of the process of targeting thrombolyticand angioplasty care to particular patient groups.Barton S. Walley T. Cost implications of prehospital emergency drugadministration: the case of prehospital thrombolytics. PhannacoEconomics10: 441-452. Nov 1996 100475710</p><p>1173-5503I96/OO89-00051$01.00CAdl. InterrwtloNlI Limited 1996. All righte reeerved PharmacoEconomics &amp; Outcomes News 23 Nov 1996 No. 89</p><p>5</p></li></ul>


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