Cost-effectiveness of reperfusion strategies.

Reperfusion of acute myocardial infarction has become the standard of management during the first few hours. Cost per year of life saved is one measure of the effectiveness of reperfusion strategies. Estimates of the cost per year of life saved have been approximately $17,000 for streptokinase and percutaneous transluminal coronary angioplasty and approximately $33,000 for tissue plasminogen activator. Assuming that percutaneous transluminal coronary angioplasty is more effective than thrombolysis, we calculated the cost-effectiveness of this strategy in different hospital settings. The estimated costs in hospitals with existing cardiac catheterization laboratories were $11,000 per year of life saved for primary angioplasty and $14,000 for thrombolysis compared with no intervention. In hospitals without catheterization facilities, it would be cost-ineffective to build such laboratories only to treat acute infarction with angioplasty. Preliminary results suggest that stenting may also be cost-effective in association with angioplasty.