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dc.contributor.authorScuffham, Paul A
dc.contributor.authorTippett, Vivienne
dc.contributor.editorDr. Dimitri Mikhailidis (Editor-in-Chief), Piers R Allen (Managing Editor)
dc.date.accessioned2017-05-03T15:06:41Z
dc.date.available2017-05-03T15:06:41Z
dc.date.issued2008
dc.date.modified2010-06-24T05:22:25Z
dc.identifier.issn0300-7995
dc.identifier.doi10.1185/03007990802224762
dc.identifier.urihttp://hdl.handle.net/10072/22164
dc.description.abstractObjective: The objective of this study is to estimate the expected health outcomes, costs and cost-effectiveness of changing from current practice, where thrombolytic therapy is given in hospital, to paramedic practice where thrombolytic therapy is administered by appropriately trained paramedics (pre-hospital) for STEMI patients. Methods: A decision-analysis microsimulation model was constructed with a 30-day component and a long-term health state transition component. A brief review of the literature was undertaken to obtain data on time-to-needle to populate the model. The primary health outcome was quality-adjusted life years (QALYs); secondary outcomes included cardiac events, procedures and survival. Costs to the Australian healthcare system for the rest of life were taken as the analytical perspective. Results: On average, STEMI patients gain 0.13 QALYs at an additional life-time cost of $343. The incremental cost-effectiveness ratios were $3428 per life-year gained and $2601 per QALY gained. These estimates were robust to changes in a range of assumptions and parameter values. The most important factor was the timeto- needle - the greater the difference between current practice times and paramedic practice times, the greater the health benefits and lower the cost per QALY (and life-year) gained. A key factor in the model was the substantially lower incidence of heart failure from earlier time-to-needle. Importantly, there was little change in the cost per QALY gained for a wide range of ages; thus, there is no argument to limit thrombolysis by paramedics to above or below an age threshold. Conclusions: Paramedics administering thrombolysis can avert some STEMI deaths and the pre-hospital administration of thrombolysis is good value for money.
dc.description.peerreviewedYes
dc.description.publicationstatusYes
dc.format.extent225936 bytes
dc.format.mimetypeapplication/pdf
dc.languageEnglish
dc.language.isoeng
dc.publisherLibrapharm Ltd
dc.publisher.placeUK
dc.publisher.urihttps://www.tandfonline.com/doi/full/10.1185/03007990802224762
dc.relation.ispartofstudentpublicationN
dc.relation.ispartofpagefrom2045
dc.relation.ispartofpageto2058
dc.relation.ispartofissue7
dc.relation.ispartofjournalCurrent Medical Research and Opinion
dc.relation.ispartofvolume24
dc.rights.retentionY
dc.subject.fieldofresearchBiomedical and clinical sciences
dc.subject.fieldofresearchEconomics
dc.subject.fieldofresearchcode32
dc.subject.fieldofresearchcode38
dc.titleThe cost-effectiveness of Thrombolysis administered by paramedics
dc.typeJournal article
dc.type.descriptionC1 - Articles
dc.type.codeC - Journal Articles
gro.facultyGriffith Health, School of Medicine
gro.rights.copyright© 2008 Taylor & Francis. This is the author-manuscript version of the paper. Reproduced in accordance with the copyright policy of the publisher. Please refer to the journal's website for access to the definitive, published version.
gro.date.issued2008
gro.hasfulltextFull Text
gro.griffith.authorScuffham, Paul A.


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