A cost-effective analysis of primary coronary angioplasty versus thrombolysis for acute myocardial infarction

Boer, Menko Jan de; Hout, Ben A. van; Liem, Ay Lee; Suryapranata, Harry; Hoorntje, Jan C.A.; Zijlstra, Felix

doi:10.1016/s0002-9149(99)80238-0

Cited by 78 publications

(22 citation statements)

References 8 publications

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“…Costs of acute MI and stroke after hospitalization were calculated by use of overall costs. 18, 19 The direct in-hospital costs were used as an estimate of unit costs of angioplasty or bypass surgery during follow-up. Sick leave was assessed over a period of 4 weeks at baseline and before every follow-up time.…”

Section: Secondary End Pointsmentioning

confidence: 99%

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Eefting¹,

Nathoe²,

Dijk³

et al. 2003

Circulation

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Background-Stenting improves cardiac outcome in comparison with balloon angioplasty. Compared with conventional surgery, off-pump bypass surgery on the beating heart without cardiopulmonary bypass may reduce morbidity, hospital stay, and costs. The purpose, therefore, was to compare cardiac outcome, quality of life, and cost-effectiveness 1 year after stenting and after off-pump surgery. Methods and Results-Patients referred for angioplasty (nϭ280) were randomly assigned to stenting (nϭ138) or off-pump bypass surgery. At 1 year, survival free from stroke, myocardial infarction, and repeat revascularization was 85.5% after stenting and 91.5% after off-pump surgery (relative risk, 0.93; 95% CI, 0.86 to 1.02). Freedom from angina was 78.3% after stenting and 87.0% after off-pump surgery (Pϭ0.06). Quality-adjusted lifetime was 0.82 year after stenting and 0.79 year after off-pump surgery (Pϭ0.09). Hospital stay after the initial procedure was 1.43 and 5.77 days, respectively (PϽ0.01). Stenting reduced overall costs by $2933 (26.2%) per patient ($8276 versus $11 209; PϽ0.01). Stenting was more cost-effective in 95% of the bootstrap estimates. Conclusions-At 1 year, stenting was more cost-effective than off-pump surgery while maintaining comparable cardiac outcome and quality of life. Stenting rather than off-pump surgery, therefore, can be recommended as a first-choice revascularization strategy in selected patients.

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Section: Secondary End Pointsmentioning

confidence: 99%

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Eefting¹,

Nathoe²,

Dijk³

et al. 2003

Circulation

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“…Alongside this trial, an economic evaluation was done [10]. Effects were measured in terms of event-free survival after 1 year, here defined as survival without recurrent myocardial infarction, stroke or additional revascularization procedures.…”

Section: Illustration 1: Angioplasty Vs Streptokinasementioning

confidence: 99%

Sample size calculation in economic evaluations

Hout

Michel

et al. 1998

Health Econ.

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A simulation method is presented for sample size calculation in economic evaluations. As input the method requires: the expected difference and variance of costs and effects, their correlation, the significance level (alpha) and the power of the testing method and the maximum acceptable ratio of incremental effectiveness to incremental costs. The method is illustrated with data from two trials. The first compares primary coronary angioplasty with streptokinase in the treatment of acute myocardial infarction, in the second trial, lansoprazole is compared with omeprazole in the treatment of reflux oesophagitis. These case studies show how the various parameters influence the sample size. Given the large number of parameters that have to be specified in advance, the lack of knowledge about costs and their standard deviation, and the difficulty of specifying the maximum acceptable ratio of incremental effectiveness to incremental costs, the conclusion of the study is that from a technical point of view it is possible to perform a sample size calculation for an economic evaluation, but one should wonder how useful it is.

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“…However, the long-term effectiveness of this procedure in STEMI patients can be reduced by restenosis, which requires repeated target lesion revascularization (TLR) in a consistent number of patients [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

An angiographic evaluation of restenosis rate at a six-month follow-up of patients with ST-elevation myocardial infarction submitted to primary percutaneous coronary intervention

Giglioli

Valente

Margheri

et al. 2009

International Journal of Cardiology

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A cost-effective analysis of primary coronary angioplasty versus thrombolysis for acute myocardial infarction

Cited by 78 publications

References 8 publications

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Randomized Comparison Between Stenting and Off-Pump Bypass Surgery in Patients Referred for Angioplasty

Sample size calculation in economic evaluations

An angiographic evaluation of restenosis rate at a six-month follow-up of patients with ST-elevation myocardial infarction submitted to primary percutaneous coronary intervention

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