PMID- 8028463
OWN - NLM
STAT- MEDLINE
DCOM- 19940811
LR  - 20170214
IS  - 0272-989X (Print)
IS  - 0272-989X (Linking)
VI  - 14
IP  - 2
DP  - 1994 Apr-Jun
TI  - Cost-effectiveness of streptokinase for acute myocardial infarction: A combined 
      meta-analysis and decision analysis of the effects of infarct location and of 
      likelihood of infarction.
PG  - 108-17
AB  - OBJECTIVE: To determine the effects of infarct location and of the likelihood of 
      infarction on the cost-effectiveness of intravenous streptokinase (IVSK) for 
      suspected acute myocardial infarction (AMI). DESIGN: A meta-analysis of 
      short-term survival was combined with a simple decision tree to determine 
      marginal cost-effectiveness ratios for different infarct locations and different 
      likelihoods of AMI (pMI). SETTING: Six randomized trials comparing IVSK with 
      conservative treatment. PATIENTS: 31,940 patients with onset of symptoms of AMI 
      from four to 24 hours earlier and, with the exception of one trial, 
      electrocardiographic abnormalities. Patients with contraindications to 
      thrombolytic treatment such as uncontrolled hypertension were excluded. MAIN 
      RESULTS: If AMI is certain, treatment with IVSK has marginal cost-effectiveness 
      ratios for each additional life saved of $9,900, $56,600, and $28,400, 
      respectively, for patients with anterior, inferior, and other locations of AMI. 
      If pMI is 50% treatment with IVSK has marginal cost-effectiveness ratios for each 
      additional life saved of $22,700, $131,800, and $63,100, respectively, for 
      patients with anterior, inferior, and other locations of AMI. CONCLUSIONS: The 
      marginal cost-effectiveness ratio for IVSK therapy of inferior infarction is six 
      times that for anterior infarction and rises steeply as the presence of AMI 
      becomes less certain. Assuming society is willing to pay $250,000 per life saved, 
      IVSK therapy should be given if the chance of acute anterior infarction exceeds 
      7%, if the chance of inferior infarction exceeds 32%, or if the chance of 
      infarction in other locations exceeds 17%. In patients with suspected acute 
      myocardial infarction, IVSK saves lives and is a reasonable use of societal 
      resources.
FAU - Midgette, A S
AU  - Midgette AS
AD  - Department of Medicine, Cleveland VAMC, OH 44106.
FAU - Wong, J B
AU  - Wong JB
FAU - Beshansky, J R
AU  - Beshansky JR
FAU - Porath, A
AU  - Porath A
FAU - Fleming, C
AU  - Fleming C
FAU - Pauker, S G
AU  - Pauker SG
LA  - eng
GR  - LM-4493/LM/NLM NIH HHS/United States
GR  - P01-HS06503/HS/AHRQ HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Med Decis Making
JT  - Medical decision making : an international journal of the Society for Medical 
      Decision Making
JID - 8109073
RN  - EC 3.4.- (Streptokinase)
SB  - IM
MH  - Boston
MH  - Cost-Benefit Analysis
MH  - *Decision Support Techniques
MH  - Drug Costs
MH  - Electrocardiography
MH  - Hospital Costs
MH  - Humans
MH  - Infusions, Intravenous
MH  - Likelihood Functions
MH  - Myocardial Infarction/diagnosis/*drug therapy/*economics/epidemiology/pathology
MH  - Randomized Controlled Trials as Topic
MH  - Risk Factors
MH  - Streptokinase/*economics/*therapeutic use
MH  - Survival Rate
MH  - Treatment Outcome
MH  - *Value of Life
EDAT- 1994/04/01 00:00
MHDA- 1994/04/01 00:01
CRDT- 1994/04/01 00:00
PHST- 1994/04/01 00:00 [pubmed]
PHST- 1994/04/01 00:01 [medline]
PHST- 1994/04/01 00:00 [entrez]
AID - 10.1177/0272989X9401400203 [doi]
PST - ppublish
SO  - Med Decis Making. 1994 Apr-Jun;14(2):108-17. doi: 10.1177/0272989X9401400203.