Primary angioplasty versus thrombolysis for acute ST-elevation myocardial infarction: an economic analysis of the National Infarct Angioplasty Project

Allan J Wailoo ^1*, Steve Goodacre ¹, Fiona Sampson ², Monica Hernandez ¹, Christian Asseburg ³, Stephen John Palmer ⁴, Mark Sculpher ⁵, Keith Abrams ⁶, Mark A de Belder ⁷ and Huon Gray ⁸

¹ University of Sheffield, United Kingdom
² ScHARR, United Kingdom
³ Swedish Institute for Health Economics, Sweden
⁴ University of York, United Kingdom
⁵ Centre for Health Economics, UK
⁶ University of Leicester, United Kingdom
⁷ The James Cook University Hospital, Middlesbrough, United Kingdom
⁸ Southampton University Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: a.j.wailoo{at}sheffield.ac.uk.

Accepted 26 May 2009

Abstract

Objective: To estimate the cost-effectiveness of primary angioplasty compared to thrombolysis for acute ST-elevation myocardial infarction.

Design: Cost analysis of UK observational database, incorporated into decision analytic model.

Methods: We compared patients receiving treatment within a comprehensive angioplasty service to control patients receiving thrombolysis-based care. The treatment costs and delays to treatment of thrombolysis and angioplasty were estimated. These estimates were then incorporated into an existing model of cost effectiveness that synthesises evidence from 22 randomised trials to estimate health outcomes in terms of quality-adjusted life years (QALYs).

Main outcome measures: Costs from a health service perspective and outcomes measured as quality-adjusted.

Results: The mean cost of the initial treatment episode was £3,509 for thrombolysis at control sites, £5,176 for angioplasty in usual working hours at NIAP sites and an additional £245 if undertaken out of hours . Angioplasty-based care had an incremental cost of £4520 per QALY gained and 0.9 probability of being cost-effective at a threshold of £20,000 per QALY gained. This probability was >0.95 if patients were directly admitted to the cardiac catheter laboratory, 0.75 if admitted via the emergency department or coronary care unit, and 0.38 if transferred to the angioplasty centre from another hospital.

Conclusions: Overall, primary angioplasty based care is highly likely to be cost-effective at an assumed threshold of £20,000 per QALY gained. It is more likely to be cost-effective if patients are admitted directly to the cardiac catheter laboratory than via other hospital departments, or if transferred from another hospital.