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Is primary angioplasty cost effective in the UK? Results of a comprehensive decision analysis

Vergel, Yolanda Bravo, Palmer, Stephen, Asseburg, Christian, Fenwick, Elisabeth, de Belder, Mark, Abrams, Keith and Sculpher, Mark (2007) Is primary angioplasty cost effective in the UK? Results of a comprehensive decision analysis. Heart. pp. 1238-1243. ISSN 1355-6037

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Abstract

Objective: To assess the cost effectiveness of primary angioplasty, compared with medical management with thrombolytic drugs, to achieve reperfusion after acute myocardial infarction ( AMI) from the perspective of the UK NHS. Design: Bayesian evidence synthesis and decision analytic model. Methods: A systematic review was conducted and Bayesian statistical methods used to synthesise evidence from 22 randomised control trials. Resource utilisation was based on UK registry data, published literature and national databases, with unit costs taken from routine NHS sources and published literature. Main outcome measure: Costs from a health service perspective and outcomes measured as quality-adjusted life years (QALYs). Results: For the base case, the incremental cost-effectiveness ratio of primary angioplasty was pound 9241 for each additional QALY, with a probability of being cost effective of 0.90 for a cost-effectiveness threshold of pound 20 000. Results were sensitive to variations in the additional time required to initiate treatment with primary angioplasty. Conclusions: Primary angioplasty is cost effective for the treatment of AMI on the basis of threshold cost-effectiveness values used in the NHS and subject to a delay of up to about 80 minutes. These findings are mainly explained by the superior mortality benefit and the prevention of non-fatal outcomes associated with primary angioplasty for delays of up to this length.

Item Type: Article
Copyright, Publisher and Additional Information: © 2007 the authors. This paper is freely available online under the BMJ Journals unlocked scheme.
Keywords: ACUTE MYOCARDIAL-INFARCTION, PERCUTANEOUS CORONARY INTERVENTION, ECONOMIC-EVALUATION, HEART-ATTACK, UNITED-STATES, THERAPY, THROMBOLYSIS, FIBRINOLYSIS, STROKE, HEALTH
Institution: The University of York
Academic Units: The University of York > Centre for Health Economics (York)
Depositing User: Ms Diana Hilmer
Date Deposited: 05 Dec 2007 13:59
Last Modified: 16 Oct 2014 18:36
Published Version: http://dx.doi.org/10.1136/hrt.2006.111401
Status: Published
Refereed: Yes
Related URLs:
URI: http://eprints.whiterose.ac.uk/id/eprint/3511

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