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COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE

https://doi.org/10.20996/1819-6446-2011-7-2-145-150

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Abstract

Aim. To evaluate clinical and cost effectiveness of different reperfusion strategies in myocardial infarction with ST segment elevation (STEMI), including pre-hospital thrombolysis with tenecteplase.  Material and methods. Methods of cost-effectiveness analysis and economic modeling were used to calculate the costs of reperfusion in STEMI, expected number of life gains, the cost of life gains depending on reperfusion strategy (no reperfusion, percutaneous coronary intervention (PCI), prehospital thrombolysis, hospital thrombolysis).  Results. In accordance to analysis results and from economic point of view, the most effective strategy is primary PCI in patients within "therapeutic window" and pre-hospital thrombolysis in the remaining patients with STEMI. More complex strategy of patients flow control with patient division into groups of primary PCI, pre-hospital thrombolysis and hospital thrombolysis lead to decrease in reperfusion costs efficacy.  Conclusion. The reperfusion model with primary PCI in the first 120 minutes after STEMI symptoms onset, and pre-hospital thrombolysis with bolus thrombolytic administration, when PCI is not possible in this period, is the most effective economically and in respect on mortality reduction in patients with STEMI.

About the Authors

V. V. Omel'yanovskiy
Research Institute of Clinical and Economic Expertise and Pharmacoeconomics, Russian State Medical University
Russian Federation


E. V. Derkach
Research Institute of Clinical and Economic Expertise and Pharmacoeconomics, Russian State Medical University
Russian Federation


P. M. Khaylov
Research Institute of Clinical and Economic Expertise and Pharmacoeconomics, Russian State Medical University
Russian Federation


S. N. Tereshchenko
Moscow State University of Medicine and Dentistry
Russian Federation


References

1. Public health in Russia 2009: Statistical Yearbook. Moscow: Rosstat; 2009. Russian (Здравоохранение в России 2009: Статистический сборник. М.: Росстат; 2009).

2. Report of the Minister of Health, TA Golikova at a meeting on the implementation of the project party "United Russia" "Quality of Life (Health)" June 16, 2010. Available on: http://www.minzdravsoc.ru/health/prior/60/Prezentatciya_Ministra_T_A_Golikovoj_Regionalynye_programmy_razvitiya_zdravoohraneniya_15062010.ppt. Russian (Доклад Министра Здравоохранения Т.А. Голиковой на совещании по вопросам реализации партийного проекта «Единой России» «Качество Жизни (Здоровье)» 16 июня 2010. Доступен на: http://www.minzdravsoc.ru/health/prior/60/Prezentatciya_Ministra_T_A_Golikovoj_Regionalynye_programmy_razvitiya_zdravoohraneniya_15062010.ppt).

3. Boytsov S.A., Krivonos O.V., Oshchepkova E.V. Evaluating the effectiveness of the implementation of measures aimed at reducing mortality from cardiovascular disease in the regions included in the program in 2008, according to the monitoring of Health Ministry of Russia and the Register of ACS for the period from 01.01.2009 to 31.12.2009. Available on: www.cardioweb.ru/files/any/news/1.doc. Russian (Бойцов С.А., Кривонос О.В., Ощепкова Е.В. Оценка эффективности реализации мероприятий, направленных на снижение смертности от сосудистых заболеваний в регионах, включенных в программу в 2008 году, по данным мониторинга Минздравсоцразвития России и Регистра ОКС за период с 01.01.2009 по 31.12.2009. Доступно на: www.cardioweb.ru/files/any/news/1.doc).

4. Van de Werf F., Bax J., Betriu A. et al; ESC Committee for Practice Guidelines. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008;29(23):2909-2945.

5. Verheugt F.W., Gersh B.J., Armstrong P.W. Aborted myocardial infarction: a new target for reperfusion therapy. Eur Heart J 2006; 27(8): 901–904

6. National guidelines for diagnosis and treatment of patients with acute myocardial infarction with ST-segment elevation ECG. Kardiovaskulyarnaya terapiya i profilaktika 2007; 6(8) Suppl 1: 1-66. Russian (Национальные рекомендации по диагностике и лечению больных острым инфарктом миокарда с подъемом сегмента ST ЭКГ. Кардиоваскулярная терапия и профилактика 2007; 6(8) Приложение 1: 1-66).

7. NICE Technology Appraisal No. 52 Guidance on the use of drugs for early thrombolysis in the treatment of acute myocardial infarction. ISBN: 1-84257-212-1. October 2002. Available on: www.guidance.nice.org.uk/nicemedia/live/11480/32504/32504.pdf.

8. http://grls.rosminzdrav.ru/

9. Petitcolin P.B. Mortalité des idm pris en charge dans les 3 premières heures ESTIM Limou-sin. Médecine d'urgence (Paris) 2007 ; 29(3): 97-99.

10. Lambert L., Brown K., Segal E. et al. Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA 2010;303(21):2148-55

11. Kalla K., Christ G., Karnik R. et al. Implementation of Guidelines Improves the Standard of Care The Viennese Registry on Reperfusion Strategies in ST-Elevation Myocardial Infarction (Vienna STEMI Registry). Circulation 2006;113:2398-2405

12. Van Domburg R.T., Hendriks J.M., Kamp O. et al. Three years gain in life-expectancy after reperfusion therapy in acute myocardial infarction: 25-30 years follow-up of a randomized trial. P3010. Eur Heart J 2010; 31 Abstract Supplement: 495.

13. De Luca G., Suryapranata H., Ottervanger J.P., Antman E.M. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute delay counts. Circulation 2004; 109:1223-1225

14. Nallamothu B.K., Bates E.R., Herrin J. et al; NRMI Investigators. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation 2005;111:761– 767.

15. Danchin N., Coste P., Ferrie`res J. et al. for the FAST-MI Investigators. Comparison of Thrombolysis Followed by Broad Use of Percutaneous Coronary Intervention With Primary Percutaneous Coronary Intervention for STSegment- Elevation Acute Myocardial Infarction Data From the French Registry on Acute ST-Elevation Myocardial Infarction (FAST-MI). Circulation 2008;118:268–276.

16. Terkelsen С.J., Sorensen J.T., Maeng M. et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention JAMA 2010;304(7):763-771.

17. Pedley D.K., Bissett K., Connolly E.M. et al. Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics. BMJ 2003;327:22–6.

18. Chazov E.I. Russian National Congress of Cardiology, October 5-7, 2010; Moscow. Russian (Чазов Е.И. Российский национальный конгресс кардиологов, 5-7 октября 2010; Москва).

19. Danchin N., Blanchard D., Steg P.G. et al. Impact of Prehospital Thrombolysis for Acute Myocardial Infarction on 1-Year Outcome: Results From the French Nationwide USIC 2000 Registry. Circulation 2004;110;1909-1915.

20. Morrison L., Verbeek P.R., McDonald A.C. et al. Mortality and Prehospital Thrombolysis for Acute Myocardial Infarction. Meta-analysis. JAMA 2000; 283: 2686–2692.

21. Morrison L., Verbeek P.R., McDonald A.C. et al. Mortality and Prehospital Thrombolysis for Acute Myocardial Infarction. Meta-analysis. JAMA 2000; 283: 2686–2692.

22. Steg P.G., Bonnefoy E., Chabaud S. et al. Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty: Data From the CAPTIM Randomized Clinical Trial. Circulation 2003; 108: 2851−2856.

23. Taher T., Fu Y., Wagner G.S. et al Aborted myocardial infarction in patients with ST-segment elevation: Insights from the assessment of the safety and efficacy of a new thrombolytic regimen-3 trial electrocardiographic substudy. JACC 2004; 44(1): 38-43.

24. http://www.spboms.ru

25. Russian Federation Government Resolution № 1187 of 29 December 2010 on financial security in 2011 due to budgetary allocations of the federal budget of the state task for the provision of high-tech medical aid to citizens of the Russian Federation". Available on: http://www.minzdravsoc.ru/docs/government/57. Russian (Постановление Правительства РФ №1187 от 29 декабря 2010 г. “О финансовом обеспечении в 2011 году за счет бюджетных ассигнований федерального бюджета государственного задания на оказание высокотехнологичной медицинской помощи гражданам Российской Федерации“. Доступно на: http://www.minzdravsoc.ru/docs/government/57).


For citation:


Omel'yanovskiy V.V., Derkach E.V., Khaylov P.M., Tereshchenko S.N. COST-EFFECTIVENESS EVALUATION OF PREHOSPITAL THROMBOLYSIS WITH TENECTEPLASE. Rational Pharmacotherapy in Cardiology. 2011;7(2):145-150. (In Russ.) https://doi.org/10.20996/1819-6446-2011-7-2-145-150

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