Abstract | BACKGROUND: METHODS: Using an independently developed model, we predicted the benefits of tPA therapy in the 24,146 patients in the GUSTO trial and compared these predictions with the actual benefits of tPA, after classifying patients by their risks of mortality and intracranial hemorrhage. We also performed a "patient-specific" cost-effectiveness analysis among different strata of expected benefit of tPA. RESULTS: Our model predicted that among patients with myocardial infarction, 61% of the benefit of tPA use in reducing mortality accrued to only 25% of patients; treating half of patients could capture 85% of the benefit. Including the risk of intracranial hemorrhage, our model predicted that treating half the GUSTO patients with tPA and the others with streptokinase would yield similar outcomes as treating all patients with tPA, because the additional risk of intracranial hemorrhage exceeded the expected benefit in some patients. When patients were stratified into quartiles of risk, the observed outcomes in the GUSTO patients corresponded well with these predicted results. The estimated cost-effectiveness of tPA was sensitive to patient characteristics. CONCLUSION: For selected patients, use of tPA yields substantially better outcomes than streptokinase, and use of the less expensive agent is difficult to justify. For many patients, however, tPA is unlikely to provide any additional benefit and, in some patients, it may even cause net harm.
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Authors | David M Kent, Rodney A Hayward, John L Griffith, Sandeep Vijan, Joni R Beshansky, Robert M Califf, Harry P Selker |
Journal | The American journal of medicine
(Am J Med)
Vol. 113
Issue 2
Pg. 104-11
(Aug 01 2002)
ISSN: 0002-9343 [Print] United States |
PMID | 12133748
(Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S., Research Support, U.S. Gov't, P.H.S., Validation Study)
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Chemical References |
- Streptokinase
- Tissue Plasminogen Activator
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Topics |
- Adult
- Age Factors
- Cost-Benefit Analysis
- Female
- Humans
- Injections, Intravenous
- Logistic Models
- Male
- Middle Aged
- Models, Economic
- Myocardial Infarction
(diagnosis, drug therapy, mortality)
- Patient Selection
- Predictive Value of Tests
- Reproducibility of Results
- Risk Factors
- Sex Factors
- Streptokinase
(economics, therapeutic use)
- Survival Analysis
- Thrombolytic Therapy
(economics, methods)
- Tissue Plasminogen Activator
(economics, therapeutic use)
- Treatment Outcome
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