Author + information
- Earl P. Steinberg, MD, MPPa,
- Eric J. Topol, MD, FACC*,
- Julie W. Sakin, MS,
- Stephen N. Kahane, MD,
- Larry J. Appel, MD,
- Neil R. Powe, MD, MPH, MBA,
- Gerard F. Anderson, PhD,
- Jane E. Erickson, MHS and
- Alan D. Guerci, MD
- ↵∗Address for reprints: Earl P. Steinberg, MD, The Johns Hopkins University, 1830 East Monument Street, Room 8068, Baltimore Maryland 21205.
A computer model was developed to analyze the costs to Medicare and the potential procedure volume associated with alternative strategies for treatment of acute myocardial infarction. The expected cost per case to Medicare for initial hospitalization was approximately $7,200 for conventional treatment, $7,900 for treatment with intravenous streptokinase and $8,400 for treatment with recombinant tissue-type plasminogen activator (rt-PA). The expected cost per case for use of streptokinase or rt-PA in combination with cardiac catheterization performed either emergently or at 48 h was in excess of $11,000, These cost estimates do not reflect the cost of thrombolytic drugs themselves because Medicare has not adjusted its hospital payment rates to take account of such costs. Although both streptokinase and rt-PA will increase costs to Medicare for hospitalizations for acute myocardial infarction, both agents will do so at a reasonably low cost per additional life saved—between $50,000 and $60,000. Emergency and 48 h catheterization strategies are considerably less cost-effective.
Regarding procedures, this model suggests that for every 1,000 patients treatment with streptokinase will result in an additional 76 coronary angioplasty procedures and 26 coronary artery bypass operations, whereas treatment with rt-PA will result in an additional 122 angioplasty procedures and 43 bypass operations compared with conventional treatment. Thrombolytic treatment is thus likely to increase substantially the volume of cardiac catheterization, coronary engioplasty and coronary artery bypass surgery performed in the United States.
↵* From the Program for Medical Technology and Practise Assessment, Center for Hospital Finance and Management, Divisions of Cardiology and Internal Medicine and Department of Health Policy and Management, Johns Hopkins Medical Institutions, Baltimore, Maryland and Division of Cardiology, University of Michigan, Ann Arbor, Michigan USA
☆ This research was supported in part by a grant from the Johns Hopkins Medical Institutions. Dr. Steinberg is a Henry J. Kaiser Family Foundation Faculty Scholar in General Internal Medicine, Menlo Park, California.. Dr. Powe is the recipient of a Young investigator Career Development Award from the Andrew W. Mellon Foundation, New York, New York.