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Patient preferences for thrombolytic therapy in acute myocardial infarction
E J Stanek1, J W Cheng, P J Peeples
1Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy and Science, PA 19104, USA.
Insights
Patient preferences for acute myocardial infarction thrombolytic therapy reveal a significant shift from tissue plasminogen activator (tPA) to streptokinase (SK) when drug costs are considered, especially for self-payers.
Area of Science:
- Cardiology
- Pharmacoeconomics
- Health Services Research
Background:
- Optimal thrombolytic therapy for acute myocardial infarction (AMI) remains debated professionally.
- Patient perspectives on thrombolytic treatment choices for AMI have not been previously explored.
Purpose of the Study:
- To determine patient preferences for tissue plasminogen activator (tPA) versus streptokinase (SK) in treating AMI.
- To assess how clinical outcomes (mortality, stroke) and drug costs influence these preferences.
Main Methods:
- A questionnaire was administered to patients with suspected or known coronary artery disease.
- Patients evaluated treatment preferences based on GUSTO-1 trial data, drug costs, and payer perspectives (self, third-party, government).
Main Results:
- Tissue plasminogen activator (tPA) was initially preferred when considering only mortality and stroke rates (78%).
- Preference for tPA significantly decreased to 43% when drug acquisition costs were introduced, particularly under a self-pay model.
- A similar, though less pronounced, cost-driven shift towards streptokinase (SK) was observed across different payer designations.
Conclusions:
- Patient preferences for AMI thrombolytics involve a trade-off between clinical benefits and cost.
- Incorporating drug costs substantially influences patient choice, favoring SK over tPA, especially in self-pay scenarios.
- These findings highlight the importance of patient values in guiding thrombolytic therapy decisions and policy discussions.
Background:
Despite extensive professional debate regarding the optimal thrombolytic therapy strategy in acute myocardial infarction (AMI), patient preferences have not been explored.
Methods:
Preferences among patients with known or suspected coronary artery disease for treatment with tissue plasminogen activator (tPA) or streptokinase (SK) for AMI were determined using a questionnaire presenting GUSTO-1 trial and drug cost data. Preferences were based on consideration of 30-day mortality (M) alone, hemorrhagic stroke rate (SR) alone, overall preference (M + SR), drug acquisition costs, and the estimated annual costs of using a single agent to treat all AMIs. Cost-related responses were provided under payer designations of self, third-party insurance, and federal government.
Results:
The response rate was 81% (101/125 patients). tPA was preferred by 84%, and SK by 66%, for M alone and SR alone, respectively (chi 2, p < 0.01). Overall preference (M + SR) favored tPA (78%, p < 0.01). tPA preference decreased to 43% considering drug acquisition costs under the self-pay option (p < 0.01 vs M + SR). Similar trends of lesser magnitude were also observed for the third-party and government-payer options.
Conclusions:
Under conditions of zero cost and consideration of mortality plus stroke-risk data, tPA were preferred overall due to its lower mortality. Introduction of drug-cost data significantly shifted the preference toward SK, particularly under the self-payer designation. Patient preferences for thrombolytic therapy in AMI indicate tradeoffs between clinical attributes and costs, and should assist in framing medical debate and decision making.