COST-EFFECTIVENESS OF STREPTOKINASE FOR ACUTE MYOCARDIAL-INFARCTION - A COMBINED METAANALYSIS AND DECISION-ANALYSIS OF THE EFFECTS OF INFARCT LOCATION AND OF LIKELIHOOD OF INFARCTION
COST-EFFECTIVENESS OF STREPTOKINASE FOR ACUTE MYOCARDIAL-INFARCTION - A COMBINED METAANALYSIS AND DECISION-ANALYSIS OF THE EFFECTS OF INFARCT LOCATION AND OF LIKELIHOOD OF INFARCTION
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DOI：
10.1177/0272989x9401400203
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发表时间：
1994-04-01
影响因子：
3.6
通讯作者：
PAUKER, SG
中科院分区：
文献类型：
--
作者：
MIDGETTE, AS;WONG, JB;PAUKER, SG
目的：探讨梗死部位和梗死可能性对静脉注射链激酶（IVSK）治疗疑似急性心肌梗死（AMI）成本-效果的影响。设计：短期生存的荟萃分析与简单决策树相结合，以确定不同梗死部位和不同AMI可能性（pMI）的边际成本-效果比。背景：六项比较IVSK与保守治疗的随机试验。患者：31,940例早4至24小时出现AMI症状的患者，除一项试验外，心电图异常。排除有溶栓治疗禁忌症的患者，如未控制的高血压。主要结果：如果AMI是确定的，对于AMI前、下、其他部位的患者，IVSK治疗每额外挽救生命的边际成本-效果比分别为9,900美元、56,600美元和28,400美元。如果pMI为50%，对于AMI的前部、下方和其他部位的患者，IVSK治疗的边际成本-效果比分别为22,700美元、131,800美元和63100美元。结论：IVSK治疗下壁梗死的边际成本-效果比是前壁梗死的6倍，并且随着AMI的存在变得不确定而急剧上升。假设社会愿意为每拯救一条生命支付25万美元，如果急性前壁梗死的几率超过7%，如果下壁梗死的几率超过32%，或者其他部位梗死的几率超过17%，则应给予IVSK治疗。在疑似急性心肌梗死的患者中，IVSK挽救了生命，是对社会资源的合理利用。
Objective: To determine the effects of infarct location and of the likelihood of infarction on the cost-effectiveness of intravenous streptokinase (IVSK) for suspected acute myocardial infarction (AMI). Design: A meta-analysis of short-term survival was combined with a simple decision tree to determine marginal cost-effectiveness ratios for different infarct locations and different likelihoods of AMI (pMI). Setting: Six randomized trials comparing IVSK with conservative treatment. Patients: 31,940 patients with onset of symptoms of AMI from four to 24 hours earlier and, with the exception of one trial, electrocardiographic abnormalities. Patients with contraindications to thrombolytic treatment such as uncontrolled hypertension were excluded. Main results: If AMI is certain, treatment with IVSK has marginal cost-effectiveness ratios for each additional life saved of $9,900, $56,600, and $28,400, respectively, for patients with anterior, inferior, and other locations of AMI. If pMI is 50%, treatment with IVSK has marginal cost-effectiveness ratios for each additional life saved of $22,700, $131,800, and $63,100, respectively, for patients with anterior, inferior, and other locations of AMI. Conclusions: The marginal cost-effectiveness ratio for IVSK therapy of inferior infarction is six times that for anterior infarction and rises steeply as the presence of AMI becomes less certain. Assuming society is willing to pay $250,000 per life saved, IVSK therapy should be given if the chance of acute anterior infarction exceeds 7%, if the chance of inferior infarction exceeds 32%, or if the chance of infarction in other locations exceeds 17%. In patients with suspected acute myocardial infarction, IVSK saves lives and is a reasonable use of societal resources.