Users' Guides to the Medical Literature
JAMAPublished 11 June 1997
Bernie J. OʼBrien
Citations205
SJR quartileQ1
SJR score5.35
SNIP10.71
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TL;DR
This article presents an analysis of economic data collected prospectively as part of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) and a decision-analytic model by Kalish et al.
Abstract
CLINICAL SCENARIO You recall from the first of our 2 articles1concerning economic analysis of clinical practice that your chief of medicine has asked you to review relevant economic evidence from the literature and report to the hospital's pharmacy and therapeutics committee, which is trying to decide on formulary guidelines for the use of streptokinase and tissuetype plasminogen activator (t-PA) in the treatment of acute myocardial infarction (AMI). Your literature search identified 2 recent key cost-effectiveness studies: an analysis of economic data collected prospectively as part of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial2of streptokinase vs t-PA by Mark et al,3and a decision-analytic model by Kalish et al.4In the first article of this 2-part series we showed you how to evaluate the validity of the different economic appraisal study methods. In this article, we will
Keywords
MedicineEconomics, Econometrics and Finance
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4,059 Citations1993The GUSTO Investigators
The findings of this large-scale trial indicate that accelerated t-PA given with intravenous heparin provides a survival benefit over previous standard thrombolytic regimens.
International Journal of Technology Assessment in Health CareUtilities and Quality-Adjusted Life Years
832 Citations1989George W. Torrance, David Feeny
Utilities and quality-adjusted life years (QALYs) are reviewed, with particular focus on their use in technology assessment and their interrelationship.
JAMAUsers' Guides to the Medical Literature
701 Citations1994Gordon Guyatt
A general internist is asked to see a 65-year-old man with controlled hypertension and a 6-month history of atrial fibrillation resistant to cardioversion, who has no evidence for valvular or coronary heart disease, and who shares concerns about the benefits of long-term anticoagulant therapy.
New England Journal of MedicineCost Effectiveness of Thrombolytic Therapy with Tissue Plasminogen Activator as Compared with Streptokinase for Acute Myocardial Infarction
524 Citations1995Daniel B. Mark, Mark A. Hlatky +13 more
The cost effectiveness of treatment with accelerated t-PA rather than streptokinase compares favorably with that of other therapies whose added medical benefit for dollars spent is judged by society to be worthwhile.
Medical CareIn Search of Power and Significance: Issues in the Design and Analysis of Stochastic Cost-Effectiveness Studies in Health Care
407 Citations1994Bernie J. O Brien, Michael Drummond +2 more
The feasibility and desirability of constructing statistical tests of economic hypotheses and estimation of cost-effectiveness ratios with associated 95% confidence intervals are explored and how relevant variances can be estimated are shown.
JAMAUsers' Guides to the Medical Literature
306 Citations1997Michael Drummond
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 in the treatment of acute myocardial infarction and has reached an impasse.
Journal of Health EconomicsOn the decision rules of cost-effectiveness analysis
290 Citations1993Magnus Johannesson, Milton C. Weinstein
It is shown how fixed budgets or predetermined prices per effectiveness unit can be used as decision rules to maximise health effects and to determine which programmes to implement on the basis of incremental cost-effectiveness ratios.
Social Science & MedicineCost-effectiveness league tables: More harm than good?
251 Citations1993Michael Drummond, George W. Torrance +1 more
It is concluded that, for league tables to be useful, decision makers should be able to assess the relevance and reliability of the evidence in their own setting and improve the methodology of economic evaluation studies and the construction and use of league tables.
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216 Citations1995W. Scott Richardson
The team's resident asks you whether the patient should be anticoagulated with warfarin, enough to keep his international normalized ratio from 2.0 to 3.0, in order to prevent systemic emboli, even though his echocardiogram does not show left ventricular thrombus.
International Journal of Technology Assessment in Health CareIssues in the Cross-National Assessment of Health Technology
162 Citations1992Michael Drummond, Bernard S. Bloom +6 more
The study showed that if prior agreement on methods can be reached and local data applied, economic evaluations can be undertaken in a way that facilitates the extrapolation of results from country to country.
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149 Citations1995W. Scott Richardson
This article will show how to interpret the results and generalizability of a clinical decision analysis (Table), and decision trees are displayed graphically, oriented from left to right, with the decision to be analyzed on the left, the compared strategies in the center, and the clinical outcomes on the right.
JAMAUsers' guides to the medical literature. VII. How to use a clinical decision analysis. B. What are the results and will they help me in caring for my patients? Evidence Based Medicine Working Group
120 Citations1995W. Scott Richardson
This article will show how to interpret the results and generalizability of a clinical decision analysis (Table), and decision trees are displayed graphically, oriented from left to right, with the decision to be analyzed on the left, the compared strategies in the center, and the clinical outcomes on the right.
Medical Decision MakingThe Healthy-years Equivalents
119 Citations1991Abraham Mehrez, Amiram Gafni
The authors suggest an algorithm to measure the HYE of any given lifetime health profile, based on the classic standard gamble method to measure individuals' preferences under uncertainty, and consists of two lottery questions that had not previously been used together.
JAMAVariations in patient management and outcomes for acute myocardial infarction in the United States and other countries. Results from the GUSTO trial. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries
115 Citations1995Frans Van de Werf
No significant evidence for a differentially greater benefit of accelerated rt-PA over streptokinase was found in US vs non-US patients, and increased procedure and treatment use in the United States was associated with only a small decrease in short-term mortality.
Journal of Health EconomicsChanging the problem to fit the solution: Johannesson and Weinstein's (mis) application of economics to real world problems
86 Citations1993Stephen Birch, Amiram Gafni
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74 Citations1995Bernie O'Brien
The analysis provides economic evidence in support of the recent guidance that for persons with duodenal ulcer, early attempts to eradicate H pylori are recommended.
Journal of General Internal MedicineA cost-effectiveness model of thrombolytic therapy for acute myocardial infarction
67 Citations1995Susan C. Kalish, Jerry H. Gurwitz +2 more
In spite of its higher cost relative to SK, tPA is a cost-effective therapy for MI under a wide range of assumptions regarding clinical outcomes and costs.
Annals of Internal MedicineLarge-Scale Trials of Thrombolytic Therapy for Acute Myocardial Infarction: GISSI-2, ISIS-3, and GUSTO-1
58 Citations1993Paul M. Ridker, Christopher O'Donnell +2 more
Three large-scale randomized trials directly compared the thrombolytic agents most commonly used in the United States show, at most, small absolute differences among agents, in terms of both lives saved and major complications (including hemorrhagic stroke).
Annals of Internal MedicineA Response to “Holding GUSTO Up to the Light”
27 Citations1994Paul M. Ridker, Christopher J. O'Donnell +2 more
The GustO investigators dispute the statement that no thrombolytic regimen in the GUSTO trial showed any mortality advantage for patients treated 4 or more hours after symptom onset, a critical issue because most patients with acute myocardial infarction in the United States come to the hospital during this time frame.
New England Journal of MedicineCost Effectiveness of Tissue Plasminogen Activator
12 Citations1995Thomas H. Lee
Not so long ago, therapies that led to a survival advantage in randomized trials were quickly endorsed and adopted, and the costs required to achieve the clinical benefit were of only minimal interest.