Abstract
Objective of the study: To construct a simple model for an internal, retrospective cost-effectiveness analysis and to calculate the incremental cost-effectiveness of tissue plasminogen activator (TPA) over streptokinase (SK) in Turkey.
Setting: Koşuyolu Heart, Education and Research Hospital, Istanbul, Turkey.
Method: Among patients who were hospitalized for treatment of acute myocardial infarction (AMI), 196 were randomly selected. One-year mortality rates according to the treatment groups (TPA, SK, other) were determined. Among surviving patients, 28 from TPA and another 28 from SK group were randomly selected for the pharmacoeconomic analysis. Patient treatment data were taken from medical records while data regarding to costs were taken from hospital bills.
Main outcome measures: Incremental cost-effectiveness ratio (ICER). The cost part of the ratio was considered as ‘the overall-costs’, while the effectiveness part was considered as ‘lives saved’ per treatment group.
Results: With an increased one-year survival rate of 2.37% and an increased cost of €1120.8 ($1165.6) per patient in the TPA group, the ICER for the use of TPA instead of SK was €47,289 ($49,180.6) per life saved.
Conclusion: This model can be a guide for similar analyses. The results of our study (the incremental cost-effectiveness of TPA over SK) will be informative for the decision-makers in Turkey, by whom the medical benefit for money spent would be assessed and judged. We believe that our results make a contribution to similar studies in the literature.
Similar content being viewed by others
References
DB Mark MA Hlatky RM Califf et al. (1995) ArticleTitleCost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction N Engl J Med 332 1418–24 Occurrence Handle10.1056/NEJM199505253322106 Occurrence Handle7723799
V Goel CD. Naylor (1992) ArticleTitlePotential cost-effectiveness of intravenous tissue plasminogen activator versus streptokinase for acute myocardial infarction Can J Cardiol 8 31–8 Occurrence Handle1617509
ML Simoons J Vos LL. Martens (1991) ArticleTitleCost-utility analysis of thrombolytic therapy Eur Heart J 12 694–9 Occurrence Handle1907241
A Pelc J Dardenne JH Frelon et al. (1997) ArticleTitleIncremental cost-effectiveness ratio of alteplase in patients with acute myocardial infarction in the French setting Pharmacoeconomics 11 595–605 Occurrence Handle10173031
R Lorenzoni D Pagano G Mazzotta et al. (1998) ArticleTitlePitfalls in the economic evaluation of thrombolysis in myocardial infarction: the impact of national differences in the cost of thrombolytics and of differences in the efficacy across patient subgroups Eur Heart J 19 1518–24 Occurrence Handle10.1053/euhj.1998.1092 Occurrence Handle9820990
L. Tavazzi (1999) ArticleTitleClinical epidemiology of acute myocardial infarction Am Heart J 138 S48–S54 Occurrence Handle10426859
InstitutionalAuthorNameThe Thrombolysis Early in Acute Heart Attack Trial Study Group. (1990) ArticleTitleVery early thrombolytic therapy in suspected acute myocardial infarction Am J Cardiol 65 401–7
ML Simoons J Vos JGP. Tijssen (1989) ArticleTitleLong-term benefit of early thrombolytic therapy in patients with acute myocardial infarction: 5 year follow-up of a trial conducted by the Interuniversity Cardiology Institute of the Netherlands J Am Coll Cardiol 14 1609–15 Occurrence Handle2584547
InstitutionalAuthorNameFibrinolytic Therapy Trialists’ (FTT) Collaborative Group. (1994) ArticleTitleIndications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients Lancet 343 311–22
F. Vande Werf (1999) ArticleTitleWhat do new lytics add to t-PA? Am Heart J 138 S115–S20 Occurrence Handle10426869
LE. Basskin (1998) Practical Pharmacoeconomics Advanstar Indianapolis
T.R. Prime Ministry-State Planning Organization. Long-Term Strategy and Eight Five-Year Development Plan 2001–2005. Ankara: 2001
GL Laffel HV Fineberg E Braunwald et al. (1987) ArticleTitleA cost-effectiveness model for coronary thrombolysis/reperfusion therapy J Am Coll Cardiol 10 79B–90B Occurrence Handle2959718
LA Levin B. Jönsson (1992) ArticleTitleCost-effectiveness of thrombolysis-a randomized study of intravenous rt-PA in suspected myocardial infarction Eur Heart J 13 2–8
ML Simoons J Vas JGP Tijssen et al. (1989) ArticleTitleLong term benefit of early thrombolytic therapy in patients with acute myocardial infarction J Am Coll Cardiol 14 1609–15 Occurrence Handle2584547
RM Califf HD White F Werf Particlevan de et al. (1996) ArticleTitleOne-year results from the Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries (GUSTO-I) Trial Circulation 94 1233–8 Occurrence Handle8822974
RG Wilcox G Lippe Particlevon der CG Olsson et al. (1990) ArticleTitleEffects of alteplase in acute myocardial infarction: 6-month result from the ASSET Study – Anglo-Scandinavian Study of Early Thrombolysis Lancet 335 1175–8 Occurrence Handle1971034
InstitutionalAuthorNameGruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico. (1987) ArticleTitleLong-term effects of intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study Lancet 2 871–4
C Baigent R Collins Group. fortheISIS Collaborative (1993) ArticleTitleISIS-2: 4-year mortality follow-up of 17,187 patients after fibrinolytic and antiplatelet therapy in suspected acute myocardial infarction Circulation 88 IssueIDSuppl I 1–291
Naylor CD, Bronskill S, Goel V. (1992). Reprint of ‘Canadian Consensus Conference on Coronary Thrombolysis’ – Part IV: Economics
InstitutionalAuthorNameISIS-3 (Third International Study of Infarct Survival) Collaborative Group. (1992) ArticleTitleISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41299 cases of suspected acute myocardial infarction Lancet 339 753–70
InstitutionalAuthorNameThe Gusto Investigators. (1993) ArticleTitleAn international randomized trial comparing four thrombolytic strategies for acute myocardial infarction N Engl J Med 329 673–82
M Farkouh U D DL. Sackett (1994) ArticleTitleThrombolytic agents: the science of the art of choosing the better treatment Ann Intern Med 120 886–8 Occurrence Handle8154648
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Rabuş, Ş.A., lzzettin, F.V., Sancar, M. et al. Cost-Effectiveness of Thrombolytics: A Simplified Model. Pharm World Sci 27, 243–248 (2005). https://doi.org/10.1007/s11096-004-4097-8
Issue Date:
DOI: https://doi.org/10.1007/s11096-004-4097-8