Costs and effectiveness of prehospital thrombolysis need to be clear

doi:10.1136/bmj.327.7422.1051-a

BMJ 2003;327:1051 (1 November), doi:10.1136/bmj.327.7422.1051-a

Letter

Costs and effectiveness of prehospital thrombolysis need to be clear

The first 150 words of the full text of this article appear below.

EDITOR—Pedley et al provide further evidence that paramedicalstaff providing prehospital thrombolysis for acute myocardialinfarction is feasible and reduces the treatment delay.¹ However,no cost data were presented.

The authors say that two extra lives might be expected to besaved per 100 patients treated. It is unclear how this estimatewas derived. We suspect that this is from the meta-analysisby Boersma et al.² Importantly, this health benefit of a onehour reduction in the treatment delay must be within three hoursfrom symptom onset. Pedley et al describe collecting times ofonset of symptoms but do not present their results. This isan important omission as the mortality benefit of thrombolysisis directly related to treatment delay from the time of theonset of symptoms. The health benefit of a one hour decreasein treatment delay will be considerably reduced if the totaldelay is . . . [Full text of this article]

M Kroese, specialist registrar in public health medicine

Public Health Genetics Unit, Cambridge CB1 8RN markk@srl.cam.ac.uk

D Kanka, director of public health

South Cambridgeshire Primary Care Trust, Cambridge CB1 5EE david.kanka@southcambs-pct.nhs.uk

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Prospective observational cohort study of time saved by prehospital thrombolysis for ST elevation myocardial infarction delivered by paramedics: David K Pedley, Kim Bissett, Elizabeth M Connolly, Carol G Goodman, Ian Golding, T H Pringle, G P McNeill, S D Pringle, and M C Jones
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