An economic evaluation of thrombolysis in a remote rural community

L Vale, J Silcock, J Rawles

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Abstract

Objectives: To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis.

Design: Economic evaluation based on the results of the Grampian region early anistreplase trial.

Setting: 29 rural general practices and one secondary care provider in Grampian, Scotland.

Subjects: 311 patients recruited to the Grampian region early anistreplase trial.

Interventions: Intravenous anistreplase given either by general practitioners or secondary care clinicians.

Main outcome measures: Survival at 4 years and costs of administration of thrombolysis.

Results: Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of £425 per patient. This gives a marginal cost of life saved at 4 years of £3890 (£1990 to £42 820).

Conclusions: The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.
Original languageEnglish
Pages (from-to)570-572
Number of pages3
JournalBritish Medical Journal
Volume314
Publication statusPublished - 22 Feb 1997

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Vale, L., Silcock, J., & Rawles, J. (1997). An economic evaluation of thrombolysis in a remote rural community. British Medical Journal, 314, 570-572.