A decision analysis estimated that accelerated tPA provides 255 quality-adjusted days of life compared to 150 days with streptokinase for the average patient with suspected myocardial infarction.
Does accelerated tPA improve quality-adjusted life expectancy compared to streptokinase in patients with suspected myocardial infarction?
Decision analysis suggests accelerated tPA provides greater quality-adjusted life expectancy than streptokinase for suspected MI within six hours of symptom onset, despite higher costs.
Absolute Event Rate: 255% vs 150%
PURPOSE: A computerized decision analysis, based on the results of published clinical trials, assessed the risks, benefits, and costs of different thrombolytic regimens for suspected myocardial infarction (MI) throughout the likely range of clinical circumstances. DATA SOURCE: Medline search and articles' bibliographies. STUDY SELECTION: All studies reporting efficacy and side effects of thrombolysis. DATA ANALYSIS: Life-expectancy outcomes of thrombolytic therapies for possible MI modeled by decision analysis. RESULTS: The analysis allows a clinician to estimate the benefits, risks, and relative costs of thrombolytic therapies throughout the likely range of individual clinical circumstances. When applied, for example, to the average patient in ISIS-2, estimated gains are 150 quality-adjusted days of life (QALDs) from treatment with streptokinase (SK) and 255 QALDs with "accelerated" tPA (tPA). tPA costs 1, 686 more than SK, taking into account the cost of lifelong care of the extra strokes incurred. Nevertheless, the chances of stroke above which thrombolysis is not preferred are 5. 0% for SK and 8. 0% for tPA, with tPA remaining the preferred treatment for six hours after symptom onset; thereafter, SK is marginally preferred, but at much lower cost. Both regimens are beneficial in older patients provided the chances of MI and death are "average" or greater. CONCLUSION: When the chances of MI and death are known, decision analysis can be a useful bedside tool to guide thrombolytic therapy and subsequently, if needed, to review and defend the treatment decisions made.
Kellett et al. (Sun,) conducted a other in Suspected myocardial infarction. Accelerated tissue plasminogen activator (tPA) vs. Streptokinase (SK) was evaluated on Quality-adjusted days of life (QALDs). A decision analysis estimated that accelerated tPA provides 255 quality-adjusted days of life compared to 150 days with streptokinase for the average patient with suspected myocardial infarction.