caa a22 4500 477062091 CHVBK 20180405111403.0 cr unu---uuuuu 170330e19960601xx s 000 0 eng 10.1007/BF00132408 doi (NATIONALLICENCE)springer-10.1007/BF00132408 Mark Daniel Outcomes Research and Assessment Group, Duke University Medical Center, UK. aut Economics and quality of life after acute myocardial infarction: Insights from GUSTO-I [Elektronische Daten] [Daniel Mark] Reperfusion therapy for acute myocardial infarction is one of the most thoroughly studied treatments in all of medicine. The GISSI-1 and ISIS-2 megatrials definitively established the superiority of intravenous streptokinase over conservative care for this condition. Tissue plasminogen activator (t-PA) was introduced with the expectation that it would be substantially more effective than streptokinase. It was also priced at approximately $2000 more than streptokinase, a cost differential that set the stage for a heated and often contentious debate about the added value of t-PA. Two European trials, GISSI-2 and ISIS-3, subsequently found that t-PA and streptokinase provided equivalent health outcomes. It was in this setting that the GUSTO trial was conceived. The major result of GUSTO was the finding that accelerated t-PA saved 11 additional lives per 1000 patients treated. In order to address the question of whether the extra benefits of t-PA were worth its significant extra costs, we performed a detailed cost-effectiveness analysis using the empirical data from the GUSTO-I trial. The net incremental cost for each patient shifted from streptokinase to t-PA in GUSTO-I was $2845. the majority of this difference was attributable to the difference in the cost of the thrombolytic agents. Survival modeling showed that accelerated t-PA added 0.14 undiscounted years per patient or, alternatively, that each of the 11 extra survivors per 1000 patients shifted from streptokinase to t-PA lived an average of 14 additional years. The incremental cost-effectiveness ratio for routine substitution of t-PA for streptokinase was $32,678 per added life year. Compared with standard benchmarks, our analysis shows that routine substitution of t-PA for streptokinase is "economically attractive.” Subgroups analysis further showed that cost-effectiveness ratios were most favorable in older patients and in anterior myocardial infarctions. Perhaps one of the most important results of the GUSTO-I trial is that it demonstrates that an expensive new biotechnology therapy can have a favorable economic profile if it produces sufficient additional health benefits. Kluwer Academic Publishers, 1996 myocardial infarction nationallicence thromblytic therapy nationallicence cost effectiveness nationallicence economics nationallicence Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 3/2(1996-06-01), 151-155 0929-5305 3:2<151 1996 3 11239 https://doi.org/10.1007/BF00132408 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/BF00132408 text/html Onlinezugriff via DOI NATIONALLICENCE 100 1- Mark Daniel Outcomes Research and Assessment Group, Duke University Medical Center, UK aut NATIONALLICENCE 773 0- Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 3/2(1996-06-01), 151-155 0929-5305 3:2<151 1996 3 11239 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer