Author + information
- Lee Goldman, MD, FACC∗
- ↵∗Address for correspondence: Dr. Lee-Goldman, University of California-San Francisco School of Medicine, 505 Parnassus Avenue, San Francisco, California 94143.
In an era of limited health care resources, analyses of the cost-effectiveness of cardiac interventions are becoming increasingly important. By generally accepted cost-effectiveness methodologies, the incremental cost for thrombolysis with streptokinase in patients with acute myocardial infarction ranges from ∼$3,500 to ∼$21,000/year of life saved. The estimated incremental cost-effectiveness of tissue-type plasminogen activator (t-PA) compared with streptokinase ranges from ∼$16,000 to $60,000/year of life saved. Pooled results of three randomized trials suggest that primary angioplasty can reduce mortality by as much as 63% without any increase in cost. This potential benefit is substantially greater than the 10% to 15% relative mortality rate reduction for each hour earlier that thrombolytic therapy is administered or the 12% relative benefit suggested for accelerated t-PA compared with that for streptokinase. Large-scale randomized trials are encouraged to determine whether the cost and mortality of population-based strategies using primary angioplasty are better than strategies that rely on intravenous thrombolysis.