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Cost-effectiveness of interventions to reduce the thrombolytic delay for acute myocardial infarction

Published online by Cambridge University Press:  01 August 2004

Helle Wallach Kildemoes  and
Ivar Sønbø Kristiansen
Helle Wallach Kildemoes
Affiliation:
University of Southern Denmark
Ivar Sønbø Kristiansen
Affiliation:
University of Southern Denmark
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Abstract

Objectives: The objective of the study was to estimate the costs and health benefits of a public awareness campaign aimed at shortening the delay for thrombolytic therapy in patients with acute myocardial infarction (AMI) and to estimate the incremental costs and benefits of an additional telemedicine program.

Methods and Results: By using trial data on the impact of a Swedish campaign, a model was developed to simulate the current distribution of thrombolytic delay in Denmark and the delay after a campaign. The reduction in delay was translated into reduced fatality assuming reductions from the campaign and additional effects of a telemedicine program. The costs of the campaign were based on trial data and Danish unit costs while telemedicine costs were taken from a Danish demonstration program. The analyses indicate that the awareness campaign will translate into five fewer fatal AMIs (sixty-two life years gained) and a cost per life year of DKK283,300, with both costs and benefits discounted at 5 percent. When combining the public campaign with prehospital telemedicine diagnostics, the incremental cost per life year gained was DKK854.700.

Conclusions: Programs aimed at reducing delay of thrombolysis in patients with AMI are likely to have a limited impact on AMI fatality. Information campaigns may have acceptable cost-effectiveness ratios, while telemedicine programs lead to threefold greater ratios. Whether such programs can be considered cost-effective will depend on how life year gains are valued by society.

Keywords

Myocardial infarctionThrombolytic therapyDelayEconomics
Type
RESEARCH REPORTS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 3 , August 2004 , pp. 368 - 374
Copyright
© 2004 Cambridge University Press

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References

Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Lancet. 1986 1: 397– 402.
Indications for fibrinolytic therapy in suspected acute myocardial infarction: Collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Lancet. 1994 343: 311– 322.
1999. [Befolkningens bevægelser 1997—Vital statistics 1997]. Copenhagen: Statistics Denmark
Andersen HR, Nielsen TT, Vesterlund T, et al. Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: Rationale and design of the Danish trial in acute myocardial infarction-2. Am Heart J. 2003 146: 234– 241.Google Scholar
Blohm M, Herlitz J, Schroder U, et al. Reaction to a media campaign focusing on delay in acute myocardial infarction. Heart Lung. 1991 20: 661– 666.Google Scholar
Blohm MB. 1997. Delay time until delivery of treatment in suspected acute myocardial infarction. An intervention study with particular emphasis on patient delay. Göteborg:
Blohm MB, Hartford M, Karlson BW, Luepker RV, Herlitz J. An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital. Heart. 1996 76: 430– 434.Google Scholar
Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: Reappraisal of the golden hour. Lancet. 1996 348: 771– 775.Google Scholar
Brønnum-Hansen H, Jørgensen T, et al. Survival and cause of death after myocardial infarction. The Danish MONICA study. J Clin Epidemiol. 2001 54: 1244– 1250.Google Scholar
Drummond MF, O'Brian BJ, Stoddard GL, Torrance GW. 1999. Methods for economic evaluation of health care programmes. Oxford, New York, Toronto: Oxford University Press.
Gaspoz JM, Unger PF, Urban P, et al. Impact of a public campaign on pre-hospital delay in patients reporting chest pain. Heart. 1996 76: 150– 155.Google Scholar
Herlitz J, Blohm M, Hartford M, et al. Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction. Eur Heart J. 1992 13: 171– 177.Google Scholar
Herlitz J, Hartford M, Blohm M, et al. Effect of a media campaign on delay times and ambulance use in suspected acute myocardial infarction. Am J Cardiol. 1989 64: 90– 93.Google Scholar
Herlitz J, Hartford M, Karlson BV, et al. Effect of a media campaign to reduce delay times for acute myocardial infarction on the burden of chest pain patients in the emergency department. Cardiology. 1991 79: 127– 134.Google Scholar
Herlitz J, Hartford M, Karlson BW, et al. One-year mortality after acute myocardial infarction prior to and after the implementation of a widespread use of thrombolysis and aspirin. Experiences from the community of Goteborg, Sweden. Cardiology. 1998 89: 216– 221.Google Scholar
Ho MT, Eisenberg MS, Litwin PE, Schaeffer SM, Damon SK. Delay between onset of chest pain and seeking medical care: The effect of public education. Ann Emerg Med. 1989 18: 727– 731.Google Scholar
Holmberg M, Holmberg S, Herlitz J. Incidence, duration and survival of ventricular fibrillation in out-of-hospital cardiac arrest patients in Sweden. Resuscitation. 2000 44: 7– 17.Google Scholar
Holmberg M, Holmberg S, Herlitz J, Gardelov B. Survival after cardiac arrest outside hospital in Sweden. Swedish Cardiac Arrest Registry. Resuscitation. 1998 36: 29– 36.Google Scholar
Karagounis L, Ipsen SK, Jessop MR, et al. Impact of field-transmitted electrocardiography on time to in-hospital thrombolytic therapy in acute myocardial infarction. Am J Cardiol. 1990 66: 786– 791.Google Scholar
Kereiakes DJ, Gibler WB, Martin LH, Pieper KS, Anderson LC. Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: A preliminary report from the Cincinnati Heart Project. Am Heart J. 1992 123 (pt 1): 835– 840.Google Scholar
Luepker RV, Raczynski JM, Osganian S, et al. Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. JAMA. 2000 284: 60– 67.Google Scholar
Madsen JK, Pedersen F, Nielsen H, Jensen GV, Hansen JF. Improvement in long-term prognosis of elderly patients with acute myocardial infarction after the introduction of intravenous thrombolytic therapy. Scand Cardiovasc J. 1998 32: 365– 370.Google Scholar
Maggioni AP, Maseri A, Fresco C, et al. Age-related increase in mortality among patients with first myocardial infarctions treated with thrombolysis. The investigators of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico (GISSI-2). N Engl J Med. 1993 329: 1442– 1448.Google Scholar
Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med. 1995 332: 1418– 1424.Google Scholar
Moon JCC, Kalra PR, Coats AJS. DANAMI-2: Is primary angioplasty superior to thrombolysis in acute MI when the patient has to be transferred to an invasive centre? Cardiology. 2002 85: 199– 201.Google Scholar
Moses HW, Engelking N, Taylor GJ, et al. Effect of a two-year public education campaign on reducing response time of patients with symptoms of acute myocardial infarction. Am J Cardiol. 1991 68: 249– 251.Google Scholar
Nielsen TT, Andersen HR. 2003 [Primary percutaneous coronary intervention of ST elevation myocardial infarction, the DANAMI 2 study. The Danish Society of Cardiology]. Ugeskr Laeger. 165: 1227.Google Scholar
Ottesen MM, Kober L, Jorgensen S, Torp-Pedersen C. Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. The TRACE Study Group. Trandolapril Cardiac Evaluation. Eur Heart J. 1996 17: 429– 437.Google Scholar
Parmley WW. Cost-effectiveness of reperfusion strategies. Am Heart J. 1999 138 (pt 2): S142– S152.Google Scholar
Rasmussen CH. 2000 [Out-of-hospital cardiac arrest]. Ugeskr Laeger. 162: 3887.Google Scholar
Rustige JM, Burczyk U, Schiele R, Werner A. 1999 Media campaign on delay times in suspected myocardial infarction. The Ludwigshafen project. Abstract. Eur Heart J. 11 (Suppl): 17.Google Scholar
Videbæk J, Madsen M. 1999. Heart statistics. Copenhagen: Danish Heart Foundation and Danish Institute of Clinical Epidemiology