OBJECTIVES: To quantify the health gains and costs associated with improving ambulance and thrombolysis response times for acute myocardial infarction. DESIGN: A computer simulation model. PATIENTS/SETTINGS: Patients experiencing acute myocardial infarction in England. INTERVENTIONS: Improving the ambulance response time to 75% of calls reached within 8 minutes and the hospital arrival to thrombolysis time interval (door-to-needle time) to 75% receiving it within 30 minutes and 20 minutes, compared to best estimates of response times in the mid-1990s. MAIN OUTCOME MEASURES: Deaths prevented, life years saved, and discounted cost per life year saved. RESULTS: Improving the ambulance response to 75% of calls within 8 minutes resulted in an estimate of 5 deaths prevented or 57 life years saved per million population per year, with a discounted incremental cost per life year saved of 8540 pounds sterling over 20 years. The corresponding benefit of improving the door-to-needle time to 75% of myocardial infarction patients within 30 minutes was an estimated 2 deaths prevented and 15 life years saved per million population per year, with a discounted incremental cost per life year saved of between 10,150 pounds sterling to 54,230 pounds sterling over 20 years. Little further gain was associated with reaching the 20 minute target. Combining ambulance and thrombolysis targets resulted in 70 life years saved per million population per year. CONCLUSIONS: Improving ambulance response times appears to be cost effective. Reducing door-to-needle time will have a smaller effect at an uncertain cost. Further benefits may be gained from reducing the time from onset of symptoms to starting thrombolysis.
OBJECTIVES: To quantify the health gains and costs associated with improving ambulance and thrombolysis response times for acute myocardial infarction. DESIGN: A computer simulation model. PATIENTS/SETTINGS: Patients experiencing acute myocardial infarction in England. INTERVENTIONS: Improving the ambulance response time to 75% of calls reached within 8 minutes and the hospital arrival to thrombolysis time interval (door-to-needle time) to 75% receiving it within 30 minutes and 20 minutes, compared to best estimates of response times in the mid-1990s. MAIN OUTCOME MEASURES: Deaths prevented, life years saved, and discounted cost per life year saved. RESULTS: Improving the ambulance response to 75% of calls within 8 minutes resulted in an estimate of 5 deaths prevented or 57 life years saved per million population per year, with a discounted incremental cost per life year saved of 8540 pounds sterling over 20 years. The corresponding benefit of improving the door-to-needle time to 75% of myocardial infarctionpatients within 30 minutes was an estimated 2 deaths prevented and 15 life years saved per million population per year, with a discounted incremental cost per life year saved of between 10,150 pounds sterling to 54,230 pounds sterling over 20 years. Little further gain was associated with reaching the 20 minute target. Combining ambulance and thrombolysis targets resulted in 70 life years saved per million population per year. CONCLUSIONS: Improving ambulance response times appears to be cost effective. Reducing door-to-needle time will have a smaller effect at an uncertain cost. Further benefits may be gained from reducing the time from onset of symptoms to starting thrombolysis.
Authors: Tom Quinn; Teresa F Allan; John Birkhead; Rod Griffiths; Sylvia Gyde; R Gordon Murray Journal: Eur J Cardiovasc Nurs Date: 2003-07 Impact factor: 3.908
Authors: Helen Snooks; Wai-Yee Cheung; Jacqueline Close; Jeremy Dale; Sarah Gaze; Ioan Humphreys; Ronan Lyons; Suzanne Mason; Yasmin Merali; Julie Peconi; Ceri Phillips; Judith Phillips; Stephen Roberts; Ian Russell; Antonio Sánchez; Mushtaq Wani; Bridget Wells; Richard Whitfield Journal: BMC Emerg Med Date: 2010-01-26