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ELEANOR L. OLVEY, PHARM.D., is Graduate Student, College of Pharmacy, University of Arizona (UA), Tucson. GRANT H. SKREPNEK, PH.D., M.SC., is Assistant Professor, College of Pharmacy, and Investigator, Center of Health Outcomes and Pharmacoeconomic Research, UA. PAUL E. NOLAN, JR., PHARM.D., FCCP, FASHP, is Professor, College of Pharmacy, and Senior Clinical Scientist, Sarver Heart Center, UA.

Address correspondence to Dr. Skrepnek at the College of Pharmacy, University of Arizona, 1295 North Martin, Drachman Hall, Pulido Center, Tucson, AZ 85721 (skrepnek{at}pharmacy.arizona.edu).

Purpose. 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. Conclusion. 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. Index terms: Alteplase; Drug comparisons; Methodology; Models; Peripheral vascular diseases; Pharmacoeconomics; Thrombolytic agents; Urokinase