Objective To assess the cost-effectiveness of primary angioplasty, compared to medical management with thrombolytic drugs, to achieve reperfusion following acute myocardial infarction (AMI) from the perspective of the UK NHS.
Design Bayesian evidence synthesis and decision analytic model.
Data sources A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature.
Main outcome measure Costs from a health service perspective and outcomes in terms of quality adjusted life years (QALYs).
Results For the base-case, the incremental cost-effectiveness ratio (ICER) of primary angioplasty was GBP 9,241 per additional QALY, with a probability of being cost-effective of 0.90 for a cost-effectiveness threshold of GBP 20,000. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty.
Conclusions Primary angioplasty is cost-effective for the treatment of AMI on the basis of threshold cost-effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length.
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