Cost-effectiveness analysis of percutaneous coronary intervention versus thrombolytic therapy in patients with an ST-elevated myocardial infarction

Background/aim: An acute myocardial infarction is a life-treating condition that requires urgent hospitalization and medical treatment. An ST-elevated myocardial infarction indicates a much larger degree of myocardial necrosis and should be treated with reperfusion strategies, such as percutaneous coronary intervention or thrombolytic therapy. The aim of the study was to economically evaluate these treatment methods and determine of their cost effectiveness. Methods: A Markov model was developed using the TreeAge® software and was based on data of effectiveness and local Serbia cost calculations in the literature. The duration of one cycle was one year, and the time horizon was set to 40 cycles, i.e., 40 years. The costs and outcomes were discounted by 3% annually. A Monte Carlo simulation was performed with 1000 virtual patients, as well as a sensitivity analysis, represented by a Tornado diagram, in which the values were varied by ±50%. Results: Percutaneous coronary intervention is not a cost-effective treatment for ST-elevated myocardial infarctions. Treatment with thrombolytic therapy, i.e., streptokinase, had a better cost-effectiveness ratio given that PCI is two times more expensive per one quality adjusted life year gained, 76558 , 11 rsd/QALY for PCI vs. 37263 rsd/QALY for thrombolytic therapy. Even after parameters varying by ±50%, PCI did not become an economically viable treatment with positive net benefits. Conclusion: Our results indicated that acute myocardial infarctions with ST elevations should be treated with thrombolytic therapy because of its higher clinical effectiveness and lower costs. The aim of the further analyses should identify the patients with acute myocardial infarctions in Serbia whose condition would economically justify the use of PCI.