INCREMENTAL COST-EFFECTIVENESS RATIO OF ALTEPLASE IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION IN THE FRENCH SETTING

On the basis of data collected from general hospital centres in France on 704 patients initially presenting with acute myocardial infarction , the mean 1-year cost of treatment was calculated to be 52 160 French francs (F) per patient (1994 values). This was independent of whether the patient received thrombolysis, and included all costs associated with initial hospitalisation including a stay in intensive care, cardi ology or medical units, as well as rehospitalisations, revascularisati on procedures and any drugs prescribed. When only those patients who s urvived the initial hospitalisation were considered, the mean cost of treatment was F58 184 per patient. Among patients who received thrombo lysis during their initial hospitalisation, the respective mean 1-year costs were F74 684 per patient for those treated with alteplase and F 64 866 per patient for those treated with streptokinase (p = 0.09). Th is nonsignificant difference can be explained by the higher cost of al teplase relative to that of streptokinase, the lower mortality rate as sociated with alteplase during the initial hospitalisation period (9.2 % versus 10.6%) and the difference in the percentage of additional rev ascularisations required in the 2 treatment groups (32.8% versus 42.3% ). Combining the pharmacoeconomic data collected in the French general hospital setting with incremental patient survival data stemming from the Global Utilisation of Streptokinase and Tissue Plasminogen Activa tor for Occluded Coronary Arteries (GUSTO) trial showed that the incre mental cost-effectiveness ratio of alteplase versus streptokinase amou nted to F70 128 per life-year saved for the total group, and F52 035 p er life-year saved for those patients who survived the initial period of hospitalisation.