OBJECTIVE: We sought to explore the patient-specific cost-effectiveness in a community-based sample for a therapy for which the average cost-effectiveness in a clinical trial has been well-described. STUDY DESIGN AND SETTING: Based on a validated multivariate model, we generated predictions of the effectiveness and cost-effectiveness of t-PA compared to streptokinase on 921 consecutive patients who received thrombolytic therapy for acute myocardial infarction. RESULTS: The average cost-effectiveness of t-PA was US dollar 40,140 per life-year saved. For the quartile of patients most likely to benefit, the incremental cost-effectiveness of t-PA was US dollar 15,396. However, only 44% of patients who received thrombolytic therapy had an estimated cost-effectiveness ratio below US dollar 50,000 per year of life saved; the ratio was greater than US dollar 100,000 in 37% of treated patients. Patients in the lowest quartile of expected benefit are, overall, more likely to be harmed than to benefit from t-PA. CONCLUSION: Compared to the pattern of thrombolytic agent choice observed, targeting t-PA to the half of patients most likely to benefit could save 247 lives and US dollar 174 million nationally per year.
OBJECTIVE: We sought to explore the patient-specific cost-effectiveness in a community-based sample for a therapy for which the average cost-effectiveness in a clinical trial has been well-described. STUDY DESIGN AND SETTING: Based on a validated multivariate model, we generated predictions of the effectiveness and cost-effectiveness of t-PA compared to streptokinase on 921 consecutive patients who received thrombolytic therapy for acute myocardial infarction. RESULTS: The average cost-effectiveness of t-PA was US dollar 40,140 per life-year saved. For the quartile of patients most likely to benefit, the incremental cost-effectiveness of t-PA was US dollar 15,396. However, only 44% of patients who received thrombolytic therapy had an estimated cost-effectiveness ratio below US dollar 50,000 per year of life saved; the ratio was greater than US dollar 100,000 in 37% of treated patients. Patients in the lowest quartile of expected benefit are, overall, more likely to be harmed than to benefit from t-PA. CONCLUSION: Compared to the pattern of thrombolytic agent choice observed, targeting t-PA to the half of patients most likely to benefit could save 247 lives and US dollar 174 million nationally per year.
Authors: Tara A Lavelle; David M Kent; Christine M Lundquist; Teja Thorat; Joshua T Cohen; John B Wong; Natalia Olchanski; Peter J Neumann Journal: Med Decis Making Date: 2018-01-19 Impact factor: 2.583
Authors: Thomas W Concannon; David M Kent; Sharon-Lise Normand; Joseph P Newhouse; John L Griffith; Joshua Cohen; Joni R Beshansky; John B Wong; Thomas Aversano; Harry P Selker Journal: Circ Cardiovasc Qual Outcomes Date: 2010-07-27
Authors: David M Kent; David van Klaveren; Jessica K Paulus; Ralph D'Agostino; Steve Goodman; Rodney Hayward; John P A Ioannidis; Bray Patrick-Lake; Sally Morton; Michael Pencina; Gowri Raman; Joseph S Ross; Harry P Selker; Ravi Varadhan; Andrew Vickers; John B Wong; Ewout W Steyerberg Journal: Ann Intern Med Date: 2019-11-12 Impact factor: 25.391
Authors: H P Selker; K A Oye; H-G Eichler; N L Stockbridge; C R Mehta; K I Kaitin; N E McElwee; P K Honig; J K Erban; R B D'Agostino Journal: Clin Pharmacol Ther Date: 2013-09-23 Impact factor: 6.875