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June 11, 1997

Users' Guides to the Medical Literature: XIII. How to Use an Article on Economic Analysis of Clinical Practice B. What Are the Results and Will They Help Me in Caring for My Patients?

Author Affiliations

From the Department of Clinical Epidemiology and Biostatistics, McMaster University, and Centre for Evaluation of Medicines, St Joseph's Hospital, Hamilton, Ontario (Drs O'Brien and Levine); Royal Alexandra Hospital, Edmonton, Alberta (Dr Heyland); Department of Medicine, University of Rochester, School of Medicine and Dentistry, Rochester, NY (Dr Richardson); and the Centre for Health Economics, University of York, York, United Kingdom (Dr Drummond).

JAMA. 1997;277(22):1802-1806. doi:10.1001/jama.1997.03540460066034

CLINICAL SCENARIO  You recall from the first of our 2 articles1 concerning 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) trial2 of streptokinase vs t-PA by Mark et al,3 and a decision-analytic model by Kalish et al.4 In 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