The cost-effectiveness of thrombolysis administered by paramedics

Scuffham, P. and Tippett, Vivienne C. (2008) The cost-effectiveness of thrombolysis administered by paramedics. Current Medical Research and Opinion, 24 7: 2045-2058. doi:10.1185/03007990802224762

Author Scuffham, P.
Tippett, Vivienne C.
Title The cost-effectiveness of thrombolysis administered by paramedics
Journal name Current Medical Research and Opinion   Check publisher's open access policy
ISSN 0300-7995
Publication date 2008-06-06
Year available 2008
Sub-type Article (original research)
DOI 10.1185/03007990802224762
Volume 24
Issue 7
Start page 2045
End page 2058
Total pages 14
Editor Dr Dimitri Mikhailidis
Place of publication London, U.K.
Publisher Informa Pharmaceutical Science
Language eng
Subject C1
920499 Public Health (excl. Specific Population Health) not elsewhere classified
140208 Health Economics
1117 Public Health and Health Services
Formatted abstract
Objective: The objective of this study is to estimate the expected health outcomes, costs and cost-effectiveness of changing from current practice, where thrombolytic therapy is given in hospital, to paramedic practice where thrombolytic therapy is administered by appropriately trained paramedics (pre-hospital) for STEMI patients.

Methods: A decision-analysis microsimulation model was constructed with a 30-day component and a long-term health state transition component. A brief review of the literature was undertaken to obtain data on time-to-needle to populate the model. The primary health outcome was quality-adjusted life years (QALYs); secondary outcomes included cardiac events, procedures and survival. Costs to the Australian healthcare system for the rest of life were taken as the analytical perspective.

Results: On average, STEMI patients gain 0.13 QALYs at an additional life-time cost of $343. The incremental cost-effectiveness ratios were $3428 per life-year gained and $2601 per QALY gained. These estimates were robust to changes in a range of assumptions and parameter values. The most important factor was the time-to-needle – the greater the difference between current practice times and paramedic practice times, the greater the health benefits and lower the cost per QALY (and life-year) gained. A key factor in the model was the substantially lower incidence of heart failure from earlier time-to-needle. Importantly, there was little change in the cost per QALY gained for a wide range of ages; thus, there is no argument to limit thrombolysis by paramedics to above or below an age threshold.

Conclusions: Paramedics administering thrombolysis can avert some STEMI deaths and the pre-hospital administration of thrombolysis is good value for money.
Keyword Aged
Allied Health Personnel
Cohort Studies
Cost-Benefit Analysis
Fibrinolytic Agents/administration & dosage
Fibrinolytic Agents/economics
Health Care Costs
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ

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Created: Sat, 21 Mar 2009, 00:23:19 EST by Geraldine Fitzgerald on behalf of School of Public Health