Economic evaluation of treatment strategies for patients suffering acute myocardial infarction in Greece.

Introduction: Acute myocardial infarction (AMI) is one of the leading causes of death in Greece and elsewhere. The objective of this paper was to conduct an economic evaluation of three alternative treatment options, alteplase, reteplase, and tenecteplase, in different groups of patients.

Methods: A systematic review of the literature was undertaken to identify studies evaluating the three treatments considered. Data from selected trials were extracted and applied to a decision analytic model, which has a time horizon extending to the end of a patient's life. The health outcomes included in the analysis contain all major health events that may occur after an AMI. Total treatment cost comprises the cost of initial treatment, the cost associated with hospitalisations due to AMI and events such as stroke, reinfarction, etc., and the lifetime costs of patients surviving. The model allows for different patient sub-groups. Simulation was used to test the robustness of the findings.

Results: For the baseline group, there was no major difference between the three treatments, in terms of treatment cost and survival. Specifically, lifetime cost per patient was around Euro 18,950 (range Euro 18,947 - Euro 18,990) and overall survival was around 8.4 years (range 8.359 - 8.472). Nonetheless, for patients above the age of 75 and for patients starting treatment 4 hours after symptom onset, tenecteplase was more cost-effective compared to the other two treatments. Its incremental cost effectiveness ratio was Euro 2,205 in the former group and Euro 868 in the latter and these results reached high levels of significance.

Conclusion: Despite its higher price, in the setting of the Greek National Health Service tenecteplase is a cost-effective treatment for AMI patients, comparable to alteplase and reteplase, and it should also be included in the positive drug list along with the other two drugs. Simple price comparison of alternative treatments is not the best option for supporting decisions on pricing and reimbursement of new therapies.