Cost-effectiveness of thrombolysis—a randomized study of intravenous rt-PA in suspected myocardial infarction

The aim of this randomized placebo-controlled study is to ascertain the costs of intravenous thrombolytic therapy (rt-PA) in the first year after suspected myocardial infarction and to measure the treatment effect on quality of life. The main findings are that the direct costs (including all health care expenditure), on average were 9880 SEK higher in the rt-PA group (N = 153) than in the placebo group (N = 160). At the same time the indirect costs were 4200 SEK lower in the rt-PA group. The total cost of the first year after suspected myocardial infarction were on average 5680 SEK higher in the rt-PA group. The treatment gain in mean life expectancy calculated with a yearly mortality rate of 6% from the end of follow up was 1.25 years. Quality of life was measured using the Nottingham Health Profile and was classified according to NYHAs functional classification. The Nottingham Health Profile (NHP) results show that the rt-PA patients had a slightly higher (worse) score in all dimensions after one month with the exception of sleep. After 12 months the differences no longer exist and the rt-PA patients had even lower (better) scores in the sleep and energy dimensions. The calculated cost-effectiveness ratio varies from 3090 to 5970 SEK per life year saved and the calculated cost-utility ratio varies from 3260 SEK to 6310 SEK per QALY gained. In comparison with other heart disease treatments, intravenous thrombolysis is cost-effective.