Cost-effectiveness of urokinase and alteplase for treatment of acute peripheral artery disease: comparison in a decision analysis model.
OBJECTIVE
The cost-effectiveness of urokinase and alteplase for the treatment of acute peripheral artery disease (PAD) was compared using decision analysis.


METHODS
A literature-based decision model to evaluate cost-effectiveness was constructed using a base case of a 65-year-old man with acute PAD. Successful treatment outcomes were defined as clot lysis with a subsequent 30-day survival posttreatment. Direct medical costs were assessed from the payer perspective in the United States and analyzed using sensitivity analyses. A Monte Carlo analysis with 5000 patients was performed to obtain mean and incremental cost-effectiveness ratios (ICERs).


RESULTS
The mean cost-effectiveness ratio was $67,581 (95% confidence interval [CI], $36,899 to $108,836) per 30-day treatment success for alteplase and $78,729 (95% CI, $43,411 to $130,063 for urokinase). The ICER for urokinase relative to alteplase was $332,309 per additional 30-day treatment success (95% CI, $-565,540 to $1,661,247). Approximately 75% of simulated cases indicated that urokinase was associated with increased costs and increased treatment success compared with alteplase. Results of a post hoc sensitivity analysis indicated that dominance decreased to approximately 10% of cases only under the most strict criteria.


CONCLUSIONS
Decision analysis found an ICER of $332,309 per additional 30-day treatment success for urokinase relative to alteplase in the treatment of PAD from the perspective of the payer in the United States. In about 75% of cases resulting from a Monte Carlo simulation, urokinase was associated with increased costs and slightly increased treatment success compared with alteplase, although this finding was sensitive to the distributional assumptions made concerning certain costs in the model.
Olvey
Eleanor L
EL
College of Pharmacy, University of Arizona, Tucson, AZ 85721, USA.
Skrepnek
Grant H
GH
Nolan
Paul E
PE
D000208:Acute Disease; D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D006801:Humans; D008297:Male; D009010:Monte Carlo Method; D016491:Peripheral Vascular Diseases / Q000188:drug therapy*; D010959:Tissue Plasminogen Activator / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000191:economics / Q000627:therapeutic use*
D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator