Background: Due to limited access to primary percutaneous coronary intervention for treatment of ST-segment elevation myocardial infarction (STEMI) in low- and middle-income countries, fibrinolysis is the vital alternative treatment. We aimed to assess cost-effectiveness of tenecteplase (TNK) as compared to streptokinase (SK) for STEMI management using real world outcomes data obtained from a national electronic database.

Methods: Cost-effectiveness was analyzed using a hybrid model consisting short-term analysis using 30-days decision tree model and long-term analysis using Markov model. We assessed from both health care provider and societal perspectives over a lifetime horizon with 3% discount rate. Input parameters were derived from a national database of Thailand, a network meta-analysis and literatures review. The outcome measure was incremental cost-effectiveness ratio (ICER) determined by incremental cost per quality-adjusted life years (QALY) gain. An ICER of less than $5,590 per QALY gain is considered cost-effective. A series of sensitivity analyses was performed.

Results: From societal perspective, TNK increases cost by $827 and increases QALY by 0.173. Thus, the ICER is $4,777 per QALY gained. Similarly, the ICER from health care provider perspective is $4,664 per QALY gained. In the probabilistic sensitivity analysis, at a 5,590 USD per QALY threshold, the probability of TNK being cost-effective was 83% from both perspectives. The most influential parameters were risk ratio of 30-day mortality for treatment with TNK compared to SK and drug cost of TNK.

Conclusion: In a resource-limited country like Thailand, tenecteplase is a cost-effective fibrinolytic drug for treatment of STEMI compared to streptokinase.