Goldman L
Department of Medicine, University of California-San Francisco School of Medicine 94143, USA.
J Am Coll Cardiol. 1995 Jun;25(7 Suppl):38S-41S. doi: 10.1016/0735-1097(95)00106-e.
In an era of limited health care resources, analyses of the cost-effectiveness of cardiac interventions are becoming increasingly important. By generally accepted cost-effectiveness methodologies, the incremental cost for thrombolysis with streptokinase in patients with acute myocardial infarction ranges from approximately $3,500 to approximately $21,000/year of life saved. The estimated incremental cost-effectiveness of tissue-type plasminogen activator (t-PA) compared with streptokinase ranges from approximately $16,000 to $60,000/year of life saved. Pooled results of three randomized trials suggest that primary angioplasty can reduce mortality by as much as 63% without any increase in cost. This potential benefit is substantially greater than the 10% to 15% relative mortality rate reduction for each hour earlier that thrombolytic therapy is administered or the 12% relative benefit suggested for accelerated t-PA compared with that for streptokinase. Large-scale randomized trials are encouraged to determine whether the cost and mortality of population-based strategies using primary angioplasty are better than strategies that rely on intravenous thrombolysis.
在医疗资源有限的时代，对心脏介入治疗的成本效益分析变得越来越重要。按照普遍接受的成本效益方法，急性心肌梗死患者使用链激酶溶栓的增量成本为每年挽救一条生命约3500美元至约21000美元。与链激酶相比，组织型纤溶酶原激活剂（t-PA）的估计增量成本效益为每年挽救一条生命约16000美元至60000美元。三项随机试验的汇总结果表明，直接血管成形术可将死亡率降低多达63%，且成本没有任何增加。这一潜在益处大大高于溶栓治疗每提前一小时相对死亡率降低10%至15%，或与链激酶相比加速使用t-PA所显示的12%的相对益处。鼓励开展大规模随机试验，以确定使用直接血管成形术的基于人群策略的成本和死亡率是否优于依赖静脉溶栓的策略。
