Using estimates of the total number of people receiving thrombolysis and the mixture of thrombolytic drugs used, current annual spending on thrombolytic drugs in England and Wales is estimated to be between £13 million and £26 million (drug costs alone, excluding VAT).
If, as is believed, the current need for thrombolysis is only partly met, and more clinically eligible patients were to receive thrombolytic drugs, cost estimates would be markedly higher.
It is difficult to predict the local impact of the guidance on the hospital prescribing patterns of available thrombolytic drugs. Consequently, only approximate estimates of the likely NHS resource impact of this guidance can be made, based on possible patterns of hospital prescribing of the alternative available drugs.
Assuming that the current overall level of thrombolytic therapy remains unchanged, if streptokinase represented 20% of thrombolytic drugs prescribed, alteplase 10%, and reteplase and teneteplase each accounted for 35%, then the total annual spending on thrombolytic drugs in England and Wales would be between £27 million and £45 million. If these levels were assumed to be 35%, 20% and 22.5% respectively, then the total would be between £22 million and £36 million.
In addition, substantial costs are associated with the introduction of pre-hospital thrombolysis. These include the costs of additional equipment, training, and potentially longer ambulance time spent treating patients with AMI. Also, any expansion of pre-hospital thrombolysis would result in a shift of drug costs from acute hospital trusts to other services such as ambulance trusts or primary care trusts and, potentially, result in an increase in total local spending on thrombolytic drugs where bolus drugs were not widely used in hospital. Such costs are difficult to estimate usefully on the basis of the information available to NICE at the time of this appraisal.