Users' Guides to the Medical Literature

CLINICAL SCENARIO You recall from the first of our 2 articles 1 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) trial 2 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