dc.contributor.author | Scuffham, Paul A | |
dc.contributor.author | Tippett, Vivienne | |
dc.contributor.editor | Dr. Dimitri Mikhailidis (Editor-in-Chief), Piers R Allen (Managing Editor) | |
dc.date.accessioned | 2017-05-03T15:06:41Z | |
dc.date.available | 2017-05-03T15:06:41Z | |
dc.date.issued | 2008 | |
dc.date.modified | 2010-06-24T05:22:25Z | |
dc.identifier.issn | 0300-7995 | |
dc.identifier.doi | 10.1185/03007990802224762 | |
dc.identifier.uri | http://hdl.handle.net/10072/22164 | |
dc.description.abstract | Objective: 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.peerreviewed | Yes | |
dc.description.publicationstatus | Yes | |
dc.format.extent | 225936 bytes | |
dc.format.mimetype | application/pdf | |
dc.language | English | |
dc.language.iso | eng | |
dc.publisher | Librapharm Ltd | |
dc.publisher.place | UK | |
dc.publisher.uri | https://www.tandfonline.com/doi/full/10.1185/03007990802224762 | |
dc.relation.ispartofstudentpublication | N | |
dc.relation.ispartofpagefrom | 2045 | |
dc.relation.ispartofpageto | 2058 | |
dc.relation.ispartofissue | 7 | |
dc.relation.ispartofjournal | Current Medical Research and Opinion | |
dc.relation.ispartofvolume | 24 | |
dc.rights.retention | Y | |
dc.subject.fieldofresearch | Biomedical and clinical sciences | |
dc.subject.fieldofresearch | Economics | |
dc.subject.fieldofresearchcode | 32 | |
dc.subject.fieldofresearchcode | 38 | |
dc.title | The cost-effectiveness of Thrombolysis administered by paramedics | |
dc.type | Journal article | |
dc.type.description | C1 - Articles | |
dc.type.code | C - Journal Articles | |
gro.faculty | Griffith 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.issued | 2008 | |
gro.hasfulltext | Full Text | |
gro.griffith.author | Scuffham, Paul A. | |