Cost-utility analysis of thrombolytic therapy

An analysis of the cost-effectiveness of thrombolytic therapy was performed, based on 3- to 5-year follow-up data, from 533 patients randomized to receive conventional therapy or intracoronary streptokinase. At the 3-year follow-up, mortality was 22% in the former group and 14% after thrombolysis. The estimated average gain in life years by thrombolytic therapy was 3.4, whereas this figure was only 1.6 years in patients with inferior wall infarction, and 5.1 years in patients with anterior wall infarction. The lifetime costs for conventional therapy, estimated as ECU 15,110, were increased by ECU 5530 when thrombolytic therapy was applied, including direct treatment costs and the additional costs of extra coronary bypass surgery and PTCA. After correction for quality of life, and discounting future costs and future events at 5% year-1, the additional costs for each life year were ECU 2940 for all patients treated. This was broken down into ECU 7030 and ECU 2000 for patients with inferior and anterior wall infarction respectively. These figures compare favourably with other modes of cardiovascular therapy. Thrombolytic therapy does not substantially increase the need for bypass surgery or PTCA. It is very cost-effective, and its application should not be limited by economic resources.