An economic evaluation of thrombolysis in a remote rural community
Vale, L.; Silcock, J.; Rawles, J.
BMJ 314(7080): 570-572
1997
ISSN/ISBN: 0959-8138 PMID: 9055717 Document Number: 471016
Objectives: To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis. Design: Economic evaluation based on the results of the Grampian region early anistreplase trial. Setting: 29 rural general practices and one secondary care provider in Grampian, Scotland. Subjects: 311 patients recruited to the Grampian region early anistreplase trial. Interventions: Intravenous anistreplase given either by general practitioners or secondary care clinicians. Main outcome measures: Survival at 4 years and costs of administration of thrombolysis. Thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of pnd 425 per patient. This gives a marginal cost of life saved at 4 years of pnd 3890 ( pnd 1990 to pnd 42 820). Conclusions: The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.