An economic evaluation of thrombolysis in a remote rural community.

OBJECTIVES To assess the cost effectiveness of community thrombolysis relative to hospital thrombolysis by investigating the extra costs and benefits of a policy of community thrombolysis, then establishing the extra cost per life saved by community thrombolysis. DESIGN Economic evaluation based on the results of the Grampian region early anistreplase trial. SETTING 29 rural general practices and one secondary care provider in Grampian, Scotland. SUBJECTS 311 patients recruited to the Grampian region early anistreplase trial. INTERVENTIONS Intravenous anistreplase given either by general practitioners or secondary care clinicians. MAIN OUTCOME MEASURES Survival at 4 years and costs of administration of thrombolysis. RESULTS Relative to hospital thrombolysis, community thrombolysis gives an additional probability of survival at 4 years of 11% (95% confidence interval 1% to 22%) at an additional cost of 425 pounds per patient. This gives a marginal cost of life saved at 4 years of 3,890 pounds (1,990 pounds to 42,820 pounds). CONCLUSIONS The cost per life saved by community thrombolysis is modest compared with, for example, the cost of changing the thrombolytic drug used in hospital from streptokinase to alteplase.