Key result
In a cost-effectiveness model of submassive pulmonary embolism, alteplase plus heparin resulted in higher lifetime costs ($43,900 vs $43,300) and fewer QALYs (10.52 vs 10.57) than heparin alone.
Why the study?
Does alteplase plus heparin improve quality-adjusted life-years and reduce costs compared to heparin alone in hemodynamically stable patients with submassive pulmonary embolism?
Does alteplase plus heparin improve quality-adjusted life-years and reduce costs compared to heparin alone in hemodynamically stable patients with submassive pulmonary embolism?
Absolute Event Rate: 10.52% vs 10.57%
Routine use of thrombolysis is not cost-effective for submassive pulmonary embolism, though it may be cost-effective in selected subgroups with a higher baseline risk of death.
Thrombolysis appears dominated in submassive PE models; leaves open cost-effectiveness in higher-risk subgroups.
BACKGROUND: Thrombolytic therapy is controversial in patients with submassive pulmonary embolism. METHODS: We performed a cost-effectiveness analysis to compare health effects and costs of treatment with alteplase plus heparin sodium vs heparin alone in hemodynamically stable patients with pulmonary embolism and right ventricular dysfunction by developing a Markov model and using data from clinical trials and administrative sources. RESULTS: Based on data from a recent randomized trial, we assumed that the risk of clinical deterioration requiring treatment escalation was almost 3 times higher in patients who received heparin alone (23.2% vs 7.6%) but that the risk of death was equal in the 2 cohorts (2.7%). Based on registry data, we assumed that the risk of intracranial hemorrhage was approximately 3 times higher in patients who received alteplase plus heparin (1.2% vs 0.4%). Under these and other assumptions, thrombolysis resulted in marginally higher total lifetime health care costs ($43,900 vs $43,300) and was slightly less effective (10.52 vs 10.57 quality-adjusted life-years) than treatment with heparin alone. Thrombolysis was more effective and cost less than $50,000 per quality-adjusted life-year gained when we assumed that the baseline risk of death in the heparin group was 3 times the base-case value (8.1%) and that alteplase reduced the relative risk of death by at least 10%. CONCLUSIONS: Available data do not support the routine use of thrombolysis to treat patients with submassive pulmonary embolism. However, thrombolysis may prove to be cost-effective in selected subgroups of hemodynamically stable patients in whom the risk of death is higher.
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Daniella Perlroth (2007) studied submassive pulmonary embolism. alteplase plus heparin sodium vs. heparin alone was evaluated on quality-adjusted life-years. In a cost-effectiveness model of submassive pulmonary embolism, alteplase plus heparin resulted in higher lifetime costs ($43,900 vs $43,300) and fewer QALYs (10.52 vs 10.57) than heparin alone.
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