Relative Cost-Effectiveness of Urokinase versus Streptokinase in the Treatment of Peripheral Vascular Disease☆

A retrospective case control study of 271 patients with peripheral arterial occlusion (PAO) who were treated with urokinase (UK) or streptokinase (SK) at two clinical centers, Alexandria Hospital and the Cleveland Clinic, was performed. The primary objective was to evaluate the relative cost-effectiveness of thrombolytic therapy with SK or UK in the treatment of PAO. A secondary objective was to identify factors to which any major differences in cost-effectiveness between these two agents could be attributed. All available patients hospitalized at the two centers for PAO who underwent treatment with UK or SK from 1979 to 1987 were included. Therapeutic success was defined as complete clot lysis or partial clot lysis judged to be of clinical benefit by the attending physician, with no major bleeding or other serious complication such as renal insufficiency or death. Success rates with UK were higher than those with SK at both centers. The advantage with UK could not be explained by baseline patient characteristics. A cost-effectiveness ratio— dollars expended on medical care for up to 2 days after infusion per therapeutic success—was calculated for each of the treatments. Overall, at Alexandria Hospital, $10,700 was expended per therapeutic success with UK therapy compared with $14,500 for successful SK therapy. At the Cleveland Clinic, differences were more pronounced, with $15,000 expended per therapeutic success for UK treatment and $46,400 per success for SK treatment. Support for preference of UK therapy is provided by the consistency of results in favor of UK cost-effectiveness for subgroups of patients that were determined according to site of occlusion and type of therapy following lysis. The cost-effectiveness of UK was not dependent on the definition of patient costs associated with PAO.