Is tissue-type plasminogen activator (t-PA) worth the added expense compared to streptokinase in the treatment of acute myocardial infarction (AMI)?
This article provides a clinical scenario to guide the critical appraisal of literature regarding the cost-effectiveness and clinical utility of t-PA versus streptokinase for AMI.
CLINICAL SCENARIO You are a general internist on the staff of a large community hospital. Your chief of medicine knows of your interest in evidence-based medicine, and she asks you to help her solve a problem. The hospital's pharmacy and therapeutics committee has been trying to decide on formulary guidelines for the use of streptokinase or tissue-type plasminogen activator (t-PA) in the treatment of acute myocardial infarction (AMI). Members of the committee have been arguing for weeks about the Global Utlization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial1and whether the added expense of t-PA is worth it. The committee has reached an impasse and has asked the chief of medicine for some outside help to reach a good decision. Knowing that the hospital faces pressure to keep costs down, the chief wants good information about this question to bring to the next committee
Michael Drummond (Wed,) studied this question.
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