Simoons M L, Vos J, Martens L L
Thoraxcenter, Erasmus University, Rotterdam, The Netherlands.
Eur Heart J. 1991 Jun;12(6):694-9. doi: 10.1093/eurheartj/12.6.694.
An analysis of the cost-effectiveness of thrombolytic therapy was performed, based on 3- to 5-year follow-up data, from 533 patients randomized to receive conventional therapy or intracoronary streptokinase. At the 3-year follow-up, mortality was 22% in the former group and 14% after thrombolysis. The estimated average gain in life years by thrombolytic therapy was 3.4, whereas this figure was only 1.6 years in patients with inferior wall infarction, and 5.1 years in patients with anterior wall infarction. The lifetime costs for conventional therapy, estimated as ECU 15,110, were increased by ECU 5530 when thrombolytic therapy was applied, including direct treatment costs and the additional costs of extra coronary bypass surgery and PTCA. After correction for quality of life, and discounting future costs and future events at 5% year-1, the additional costs for each life year were ECU 2940 for all patients treated. This was broken down into ECU 7030 and ECU 2000 for patients with inferior and anterior wall infarction respectively. These figures compare favourably with other modes of cardiovascular therapy. Thrombolytic therapy does not substantially increase the need for bypass surgery or PTCA. It is very cost-effective, and its application should not be limited by economic resources.
基于对533例随机接受传统治疗或冠状动脉内链激酶治疗患者的3至5年随访数据，对溶栓治疗的成本效益进行了分析。在3年随访时，前一组的死亡率为22%，溶栓后为14%。溶栓治疗估计平均延长的生命年数为3.4年，而下壁梗死患者这一数字仅为1.6年，前壁梗死患者为5.1年。传统治疗的终身成本估计为15,110欧洲货币单位，应用溶栓治疗后增加了5530欧洲货币单位，包括直接治疗成本以及冠状动脉搭桥手术和经皮冠状动脉腔内血管成形术（PTCA）的额外成本。校正生活质量，并按每年5%对未来成本和未来事件进行贴现后，所有接受治疗患者每延长一年生命的额外成本为2940欧洲货币单位。下壁梗死患者和前壁梗死患者的这一数字分别为7030欧洲货币单位和2000欧洲货币单位。这些数字与其他心血管治疗方式相比具有优势。溶栓治疗不会大幅增加冠状动脉搭桥手术或PTCA的需求。它具有很高的成本效益，其应用不应受经济资源的限制。
