An economic evaluation of thrombolysis in a remote rural community

摘要

Objectives: To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis. Design: Economic evaluation based on the results of the Grampian region early anistreplase trial. Setting: 29 rural general practices and one secondary care provider in Grampian, Scotland. Subjects: 311 patients recruited to the Grampian region early anistreplase trial. Interventions: Intravenous anistreplase given either by general practitioners or secondary care clinicians. Main outcome measures: Survival at 4 years and costs of administration of thrombolysis. Results: Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of £425 per patient This gives a marginal cost of life saved at 4 years of £3890 (£1990 to £42 820). Conclusions: The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the fhrombolytic drug used in hospital from streptokinase to alteplase.