Primary PTCA versus thrombolysis with tPA in acute myocardial infarction: a formal cost-effectiveness analysis

Aims: Information concerning the cost-effectiveness of primary percutaneous transluminal coronary angioplasty (PTCA) compared to thrombolytic treatmen t with tissue plasminogen activator (tPA) for the management of acute myoca rdial infarction (AMI) is limited. The existing data are derived from studi es using a wide range of intervention, re-intervention and a high rate of m ortality. The present study examined the cost-effectiveness of primary PTCA compared to thrombolytic treatment with tPA in the setting of AMI by apply ing data from published prospective randomised studies. Methods and results: We performed a formal cost effectiveness analysis. As estimates for "cost" of therapy we applied the reimbursement paid by the pu blic health insurance organisations in Austria. Coronary intervention rates and re-intervention rates were extracted from published studies. Assuming a moderately reduced in-hospital mortality for patients treated with primar y PTCA (4.8%) compared to tPA (6.6%) on the basis of AMI in a 60-year-old m ale, the estimated additional cost per life saved was 274.- ECU (95% confid ence interval 231.- to 318.- ECU). However, the cost per life saved was sen sitive to the given range of intervention and re-intervention rates (range 2,518.- ECU gain to 9,560.- ECU additional cost). Conclusions: Assuming a moderate in-hospital survival benefit from treatmen t with primary PTCA in patients with AMI, PTCA seems to be cost effective i n comparison to treatment with tPA - at least from the perspective of cost reimbursement by public health insurance organisations.