FORMULA

CMA





CEA
A) A review of the literature concerning the cost-effectiveness of different thrombolytics in the
treatment of myocardial infarction was conducted in Australia. The cost of the various
treatments and the mortality rate following myocardial infarction were evaluated and the
results are shown below. Prices are given in Australian dollars (AUD).

Cost of treatment and mortality rates
No Treatment Cost of treatment
(AUD)
Mortality rates
1 Usual care of myocardial infarction (MI) 3.5 million/1000 cases 120
2 Usual care of MI + streptokinase (SK): 3.7 million/1000 cases 90
3 Usual care of MI + plasminogen activator
(TPA)
5.5 million/1000 cases 80

COMPARISON OF THE DIFFERENT TREATMENTS

1) Calculate Difference between SK and usual care of MI:
Cost of treatment = AUD3.7-3.5 million/1000 cases = $0.2 million/1000 cases = AUD200/case
No. of deaths that will be prevented = 120-90 = 30 deaths/1000 cases treated
Cost-effectiveness of SK = AUD0.2 million/30 lives = $6700 per life saved

2) Calculate Difference between TPA and usual care of MI:

Cost of treatment = AUD5.5-3.5 million/1000 cases = 2.0 million/1000 cases = AUD2000/case
No. of deaths that will be prevented = 120-80 = 40 deaths/1000 cases treated
Cost-effectiveness of TPA = AUD2.0 million/40 lives = $50 000 per life saved

3) Calculate Difference between TPA and SK treatments for MI:

Cost of treatment = AUD2.0-0.2 million/1000 cases = 1.8 million/1000 cases = AUD1800/case
No. of deaths that will be prevented = 90-80 = 10 deaths/1000 cases treated
Marginal cost of TPA over SK = AUD1.8 million/10 lives = $180 000 per life saved


If we has a budget of only AUD 500 000, which drug should one use?

For SK:

No. cases that can be treated = 500 000/200 = 2500
No. lives that can be saved = (30/1000) x 2500 = 75

For TPA:

No. cases that can be treated = 500 000/2000 = 250
No. lives that can be saved = (40/1000) x 250 = 10

Conclusion

Although TPA is slightly more efficacious and saved marginally more lives, when cost was taken into
account, more patients could be treated and more lives saved using SK. In other words, the extra
cost of TPA over SK was so high ($180 000 per life saved) that with the limited budget available
fewer people could be treated and lives saved, using TPA as compared to SK.

B) Congratulations! You have just been appointed as a member of the formulary committee of
a large teaching hospital in Sydney, Australia. A key item on the agenda for the next meeting
is a proposal to implement a management protocol for the treatment of acute myocardial
infarction. You have been asked to evaluate the available evidence and advise to the
committee as to which of two available drugs represents the more cost-effective choice.

The draft clinical management protocol currently proposes the use of the (hypothetical)
thrombolytic drug Thrombase. A new drug, Klotgon, has recently been brought to your
attention. The two drugs have been compared in a large randomized trial in which the
primary outcome of mortality was measured 30 days after randomization.
No treatment Trombase Klotgon
Drug Cost /patient ($) 0 200 1000
Outcomes in 100
patients (death)
15 10 7



You are also aware that the average survival time following non-fatal myocardial infarction is eight
years.

Please answer the following questions. Be prepared to present your findings to the large group.



a. If the hospital budget were unlimited, and if 1000 patients were to be treated, how many lives
could be saved if patients were treated with Thrombase, compared with no treatment? How many
could be saved with Klotgon, compared with no treatment?
i. Calculate Difference between Trombase and No treatment
Cost of treatment = $ 200 0 /patient = $200/patient
No. of deaths that will be prevented = 15-10= 5 deaths/100 patient treated=0.05
lives
Cost-effectiveness of Trombase = $200/0.05= $4000 per life saved
ii. Calculate Difference between Klotgon and No treatment
Cost of treatment = $ 1000 0 /patient = $1000/patient
No. of deaths that will be prevented = 15-7= 8 deaths/100 patient treated=0.08 lives
Cost-effectiveness of Klotgon = $1000/0.08= $12500 per life saved

iii. Calculate Difference between Klotgon and Trombase

Cost of treatment = $1000-200/patient= $800/patient
No. of deaths that will be prevented = 10-7= 3 deaths/100 patient treated=0.03 lives
Marginal cost of Klotgon and trombase = $800/0.03 lives = $26,700per life saved

iv. For Trombase:
1000 patient were treated
No. of deaths that will be prevented = 0.05 lives x 1000
= 50 lives can be saved
v. For Klotgon:
1000 patient were treated
No. of deaths that will be prevented = 0.08 lives x 1000
= 80 lives can be saved

b. If the hospitals budget for purchasing thrombolytics were $200 000, how many patients could be
treated, and how many lives could be saved with each of the drugs, compared with no treatment at
all?
i. For Trombase:
No. patient that can be treated = 200000/200 = 1000
No. of deaths that will be prevented = 0.05 lives x 1000
= 50 lives can be saved
ii. For Klotgon
No. patient that can be treated = 200000/1000 = 200
No. of deaths that will be prevented = 0.08 lives x 200
= 16 lives can be saved
c. What is the incremental cost per life saved, for each of the thrombolytic agents, compared with no
active treatment?
i. Cost-effectiveness of Trombase:
= $200/0.05= $4000 per life saved
ii. Cost-effectiveness of Klotgon

= $1000/0.08= $12500 per life saved
d. What are the incremental cost-effectiveness ratios (ICERs), expressed as the incremental cost per
life-year gained, for each of the thrombolytic agents, compared with no active treatment?
You are also aware that the average survival time following non-fatal myocardial infarction is eight
years.
i. Cost-effectiveness of Trombase:
= $200/8
=$25 per life year gain
ii Cost-effectiveness of Klotgon
= $1000/8
=$125 per life year gain
e. What is the ICER for Klotgon compared to Thrombase?
Cost of treatment = $1000-200/patient= $800/patient
No. of deaths that will be prevented = 10-7= 3 deaths/100 patient treated=0.03 lives
Marginal cost of Klotgon and trombase = $800/0.03 lives = $26,700per life saved


f. What will you recommend to the formulary committee?
Although Klotgon is more efficacious and saved marginally more lives, when cost was taken into
account, more patients could be treated and more lives saved using Trombase. In other words, the
extra cost of Klotgon over Trombase was high ($26700 per life saved) that with the limited budget
available fewer people could be treated and lives saved, using Klotgon as compared to Trombase.
I will recommend in using Trombase due to limited of allocation in drugs