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March 15, 1995

Placing Trials in Context Using Bayesian Analysis: GUSTO Revisited by Reverend Bayes

Author Affiliations

From the Department of Medicine, Centre Hospitalier de Verdun (Quebec) (Dr Brophy); Department of Epidemiology and Biostatistics, McGill University, Montreal, Quebec (Drs Brophy and Joseph); and Division of Clinical Epidemiology and Centre for the Analysis of Cost Effective Care, Department of Medicine, Montreal (Quebec) General Hospital (Dr Joseph).

JAMA. 1995;273(11):871-875. doi:10.1001/jama.1995.03520350053028

Standard statistical analyses of randomized clinical trials fail to provide a direct assessment of which treatment is superior or the probability of a clinically meaningful difference. A Bayesian analysis permits the calculation of the probability that a treatment is superior based on the observed data and prior beliefs. The subjectivity of prior beliefs in the Bayesian approach is not a liability, but rather explicitly allows different opinions to be formally expressed and evaluated. The usefulness of this approach is demonstrated using the results of the recent GUSTO study of various thrombolytic strategies in acute myocardial infarction. This analysis suggests that the clinical superiority of tissue-type plasminogen activator over streptokinase remains uncertain.

(JAMA. 1995;273:871-875)