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Primary angioplasty versus thrombolysis for acute ST-elevation myocardial infarction: an economic analysis of the National Infarct Angioplasty project

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Published copy (DOI)


  • Allan Wailoo
  • Steve Goodacre
  • Fiona Sampson
  • Monica Hernandez Alava
  • Christian Asseburg
  • Stephen Palmer
  • Mark Sculpher
  • Keith Abrams
  • Mark de Belder
  • Huon Gray


Publication details

DatePublished - May 2010
Issue number9
Number of pages5
Pages (from-to)668-672
Original languageEnglish


Objective To estimate the cost-effectiveness of primary angioplasty compared with thrombolysis for acute ST elevation myocardial infarction.

Design Cost analysis of UK observational database, incorporated into decision analytical model.

Methods Patients receiving treatment within a comprehensive angioplasty service were compared with control patients receiving thrombolysis-based care. The treatment costs and delays to treatment of thrombolysis and angioplasty were estimated. These estimates were then incorporated into an existing model of cost-effectiveness that synthesises evidence from 22 randomised trials to estimate health outcomes measured by quality-adjusted life years (QALYs).

Main outcome measures Costs from a health service perspective and outcomes measured as quality adjusted.

Results The mean cost of the initial treatment was 3509 pound for thrombolysis at control sites, 5176 pound for angioplasty in usual working hours at National Infarct Angioplasty Project sites and an additional 245 pound if undertaken out of hours. Angioplasty-based care had an incremental cost of 4520 pound per QALY gained and 0.9 probability of being cost-effective at a threshold of 20 pound 000 per QALY gained. This probability was >0.95 if patients were directly admitted to the cardiac catheter laboratory, 0.75 if admitted via the emergency department or coronary care unit and 0.38 if transferred to the angioplasty centre from another hospital.

Conclusions Overall, primary angioplasty-based care is highly likely to be cost-effective at an assumed threshold of 20 pound 000 per QALY gained. It is more likely to be cost-effective if patients are admitted directly to the cardiac catheter laboratory rather than via other hospital departments, or if transferred from another hospital.

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