Users' Guides to the Medical Literature: XIII. How to Use an Article on Economic Analysis of Clinical Practice A. Are the Results of the Study Valid?

CLINICAL SCENARIO You are a general internist on the staff of a large community hospital. Your chief of medicine knows of your interest in evidence-based medicine, and she asks you to help her solve a problem. The hospital's pharmacy and therapeutics committee has been trying to decide on formulary guidelines for the use of streptokinase or tissue-type plasminogen activator (t-PA) in the treatment of acute myocardial infarction (AMI). Members of the committee have been arguing for weeks about the Global Utlization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO) trial1 and whether the added expense of t-PA is worth it. The committee has reached an impasse and has asked the chief of medicine for some outside help to reach a good decision. Knowing that the hospital faces pressure to keep costs down, the chief wants good information about this question to bring to the next committee