CURRENT ISSUES

Cost implications of prehospitalthrombolysis for acute MI

Rapid prehospital administration of economicalthrombolytic agents for the treatment of acutemyocardial infarction (MI) appears to offer advantagesover hospital administration of more costly thrombo­lytics, even in urban areas, according to Dr StuartBarton and Professor Tom Walley from the Universityof Liverpool, UK.

Low incremental cost?In the UK, the relevant incremental cost of

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.

The incremental cost of prehospital administration ofstreptokinase, including organisational costs, is around£Il8/patient, compared with hospital administration ofthe drug. In contrast, the incremental cost of prehospitaladministration of anistreplase is £5811patient, comparedwith inhospital administration of streptokinase.

Depends on time saved by early useCost-effectiveness values depend on the amount of

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 > 150 minutes andstreptokinase is the thrombolytic agent used. At a timesaving of only 20 minutes, the incremental costeffectiveness of prehospital thrombolysis is around£10 OOO/additionallife saved.

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.

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

1173-5503I96/OO89-00051$01.00CAdl. InterrwtloNlI Limited 1996. All righte reeerved PharmacoEconomics & Outcomes News 23 Nov 1996 No. 89

5