An economic evaluation of thrombolysis in a remote rural community: Table 1

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. Results: Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of £425 per patient. This gives a marginal cost of life saved at 4 years of £3890 (£1990 to £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. Key messages Community thrombolysis leads to increased survival relative to hospital thrombolysis at four years Relative to hospital thrombolysis, community thrombolysis provides this extra benefit at modest extra cost Methods of motivating general practitioners and facilitating routine community thrombolysis need to be ascertained