Treatment costs of acute myocardial infarction in Switzerland: is emergency PTCA more costly than thrombolysis?

Confirming earlier studies with a lower number of patients, the Gusto IIb A ngioplasty Substudy has shown that in the treatment of acute myocardial inf arction emergency PTCA is superior to thrombolysis in reducing the combined clinical endpoints of death, reinfarction and cerebrovascular infarction, The aim of this study was to assess whether, in the Swiss study population of Gusto IIb, emergency PTCA was associated with higher procedural costs th an thrombolysis over a median follow-up of 16 months. Therefore, we compare d the costs of the initial and the follow-up hospitalisations. There were n o differences in clinical characteristics in the Swiss subpopulation compar ed to the total study population. In a total of 46 patients, PTCA was perfo rmed in 22 and thrombolysis with rtPA in 24. During follow-up, 4 patients d ied, one in the PTCA group and 3 in the thrombolysis group (p = ns). The median total costs of the initial hospitalisation were somewhat higher in the PTCA group than in the group with thrombolysis. During follow-up onl y 38% of the patients in the PTCA group had to be rehospitalised, compared to 50% in the thrombolysis group. Median total costs within 16 months, ther efore, were similar in the two therapeutic groups, but mean total costs per patient were somewhat lower for the PTCA versus the thrombolysis group (p = ns). Based on this comparison of Swiss procedural costs, emergency PTCA should n ot, in hospitals with the necessary infrastructure, be withheld in the trea tment of acute myocardial infarction on the grounds of initially higher pro cedural costs, especially as the invasive strategy is associated with a mor e favourable long-term outcome.