PHARMACOECONOMICS

Alteplase is cost effective Intravenous thrombolysis therapy with

alteplase in patients with suspected myocardial infarction (MI) has a high cost effectiveness (which varied from 3090 to 5970 SEK per life year saved) and cost-utility ratio (which varied from 3260 to 6310 SEK per quality adjusted life year gained). 'The reason seems to be that the main benefit, considerable increased survival, occurs directly without any significant prolonging increase in morbidity or reduction in quality of life.'

These results were obtained from an economic study which was conducted alongside the Anglo­Scandinavian Study of Early Thrombolysis [see Inpharma 655: 9. 17 Sep 1988]. Patients with suspected MI randomly received alteplase (n = 153) or placebo (160) within 5 hours of symptom onset.

Direct costs were significantly higher for aJteplase compared with placebo recipients, predominantly because of the cost of alteplase.

Costs associated with aI1ep1ase or pIaoebo Ihempy alter suspected myocardial InfarctIOn

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As 70% of alteplase and only 54% of placebo recipients had returned to work after 12 months and the average time spent on sick leave was shorter for alteplase compared with placebo recipients, indirect costs were lower in the alteplase group. Mean total costs were, however, higher for alteplase recipients [see figure].

Estimated from a yearly mortality rate of 6% from the end of follow-up, the treatment gain in life expectancy was 1.25 years with alteplase compared with placebo. Levin L-A. Jonsson B. Cost-effectivencss of thrombolysIs - a randomlzcd study of intravenous rt-PA in suspected myocardial infarction. European Heart Journal 13: 2-8. Jan 1992 ",'

~ Editorial comment: The Anglo-Scandinal'ian Study of Early Thrombolysis (.4 SSE T). which was conducted in 52 European cel1lres (6 of which were included in this economic study) and included 5011 patiel1ls with suspected MI. showed a 26% reduction in mortality after 1 mOl1lh in alteplase compared with placebo recipients.

The allihors of this study concluded that similar data and analyses concerning other thrombolytic agel1lS are needed before it can be decided whether alteplase is more or less cost-effective than other agents. However. the recently released findings of the 1I1lernational Study of Infarct Sun'i~'al (ISIS-3) hal'e shown that streptokinase has an equally beneficial e.ffect on mortality following MI as dllleplase. a double stranded tissue plasminogen acth'ator (see Inpharma 832:17. II

ISSN 0156-2703/92/0418-0007/$1.00/0 © Adi. hllemaliaooal lid

Apr 1992). Streptokinase is approximately I tenth the cost of alteplase. also a tissue plasminogen actil'ator. Thus. streptokinase is likely to be more cost-effective than alteplase.

INPHARMA ® 18 Apr 1992

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