Cost and health outcome of primary percutaneous coronary intervention versus thrombolysis in acute ST-segment elevation myocardial infarction—Results of the Swedish Early Decision reperfusion Study (SWEDES) trial

• Published in: The American heart journal 2010-08, Vol.160 (2), p.322-328
• Main Authors: Aasa, Mikael, MD, PhD, Henriksson, Martin, PhD, Dellborg, Mikael, MD, PhD, Grip, Lars, MD, PhD, Herlitz, Johan, MD, PhD, Levin, Lars-Åke, PhD, Svensson, Leif, MD, PhD, Janzon, Magnus, MD, PhD
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty; Angioplasty, Balloon, Coronary - economics; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Coronary heart disease; Cost-Benefit Analysis; Costs; Dermatologi och venereologi; Dermatology and Venereal Diseases; Diseases of the cardiovascular system; drug therapy; economics; Female; Heart; Heart attacks; Hospitalization; Hospitalization - economics; Hospitals; Humans; Ischemia; Male; Medical imaging; Medical sciences; MEDICIN; Medicin och hälsovetenskap; MEDICINE; Middle Aged; Mortality; Myocardial Infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - economics; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Reperfusion; Myocarditis. Cardiomyopathies; Outcome Assessment (Health Care); Percutaneous Coronary; Pharmaceuticals; Quality of Life; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Stroke; Surgery; Sweden; therapy; Thoracic surgery; Thrombolytic Therapy; Thrombolytic Therapy - economics; Transluminal; Ultrasonic imaging
• ISSN: 0002-8703; 1097-6744; 1097-6744
• DOI: 10.1016/j.ahj.2010.05.008

Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher in the PCI-treated group ($4,602 vs $3,807; P = .047), as well as the cost of drugs ($1,309 vs $1,202; P = .001), whereas the cost of hospitalization was lower ($7,344 vs $9,278; P = .025). The cost of investigations, outpatient care, and loss of production did not differ significantly between the 2 treatment arms. Total cost and quality-adjusted survival were $25,315 and 0.759 vs $27,819 and 0.728 (both not significant) for the primary PCI and thrombolysis groups, respectively. Based on the 1-year follow-up, bootstrap analysis revealed that in 80%, 88%, and 89% of the replications, the cost per health outcome gained for PCI will be