Thrombolytic therapy in the elderly. Pharmacoeconomic considerations.

Elderly patients have the highest absolute risk of death following an acute myocardial infarction (MI); 16.1% for those aged between 65 and 74 years, and 25.3% for those older than 75 years. Therefore, this age-group potentially may benefit most from the use of thrombolytic therapy. Cost-effectiveness analysis of streptokinase therapy has estimated that in patients aged 70 to 80 years, the cost per life-year saved is between $US21,200 and $US22,400 (1990 dollars) compared with placebo treatment. Additional mortality benefits have been shown for accelerated alteplase compared with streptokinase-treated patients (30-day mortality for alteplase and streptokinase was 6.3% and 7.3%, respectively; p = 0.001). A prospective cost-effectiveness study for all age groups concluded that the cost of an additional year of life saved with alteplase compared with streptokinase was $US32,678 (1993 dollars). This extra cost of alteplase treatment declined to $US13,410 and $US16,246 with patients older than 75 years with anterior and inferior MI, respectively. In patients aged 40 years or younger with an anterior or inferior MI, and for those aged up to 60 years with an inferior infarction, the accepted cost-effectiveness ratio of $US50,000 was exceeded. Alteplase appears to be a cost-effective therapy for the treatment of elderly patients with acute MI.