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Primary angioplasty versus thrombolysis for acute ST-elevation myocardial infarction: an economic analysis of the National Infarct Angioplasty project
  1. Allan Wailoo1,
  2. Steve Goodacre1,
  3. Fiona Sampson1,
  4. Mónica Hernández Alava2,
  5. Christian Asseburg3,
  6. Stephen Palmer4,
  7. Mark Sculpher4,
  8. Keith Abrams5,
  9. Mark de Belder6,
  10. Huon Gray7
  1. 1School of Health and Related Research, University of Sheffield, Sheffield, UK
  2. 2Department of Economics, University of Sheffield, Sheffield, UK
  3. 3Swedish Institute for Health Economics, Lund, Sweden
  4. 4Centre for Health Economics, University of York, York, UK
  5. 5Department of Health Sciences, University of Leicester, Leicester, UK
  6. 6The James Cook University Hospital, Middlesborough, UK
  7. 7Southampton University Hospital, Southampton, UK
  1. Correspondence to Dr Allan Wailoo, Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield S1 4DA, UK; a.j.wailoo{at}


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

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

Methods Patients receiving treatment within a comprehensive angioplasty service were compared with 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 measured by 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 was £3509 for thrombolysis at control sites, £5176 for angioplasty in usual working hours at National Infarct Angioplasty Project 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 rather than via other hospital departments, or if transferred from another hospital.

  • Primary angioplasty
  • thrombolysis
  • cost
  • cost-effectiveness
  • coronary angioplasty (PCI)

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  • Funding This work was supported by the National Institute for Health Research Service Delivery and Organisation Programme. The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. Project reference number (SDO120/2006). The funder had no role in any part of this analysis, reporting of results or the decision to submit the article for publication.

  • Competing interests MS has received consultancy fees and research funding from manufacturers of interventional cardiology equipment and pharmaceuticals. MDB has sat on advisory boards for companies manufacturing interventional cardiology equipment as well as a manufacturer of a thrombolytic agent. All other authors declare no competing interests.

  • Provenance and peer review Not commissioned; externally peer reviewed.