B PHARMACOECONOMICS

little pbarmacoeconomic data on tbromboIytD in MI

Although thrombolytic therapy after acute MI is now well accepted, there is still little cost-utility or cost-effectiveness information available. The available data, however, show this therapy to be very cost-effective compared with conventional (i.e. nonthrombolytic) care in reducing early and long-term mortality and morbidity as well as improving QOL.

Available studies indicate that, to save 1 year of life, the costs of thrombolytic therapy using IV streptokinase, alteplase or anistreplase under standard restricted indication criteria vary from £1000 to £1700 in the UK, SEK3090 to 9660 in Scandinavia and $US35 ()()() to $800 ()()() in the US. The cost depends on time delay in starting treatment after pain onset, size of infarct, thrombolytic agent used, study methodology, lists of clinical events considered in cost counting and the discount rate. Economic assessments confIrm that thrombolytic treatment of the elderly (> 70 years) is as cost-effective as treatment of younger patients and that both early and late thrombolytic therapy (Cr12h after infarction) are beneficial and cost-effective. No economic evaluation of prehospital thrombolytic therapy has been reported, but with time savings of up to 1 hour, it is unlikely to be cost-effective.

There have been no direct pharmacoeconomic comparisons between individual thrombolytic agents. Ongoing trials will hopefully provide prospective information about relative benefits and costs with different agents and adjunctive therapies. Woo KS. White HD.1'barmIcoeI:ooo upects of tratmenl of ICUtl:

myocudill infUdioo willi Ibrombolytic IFIJII. I'IIInIuIcoEcon 3: 192-204, Mao 1993 100''''''

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