Using efficacy, safety, and cost data to support a formulary decision regarding thrombolytic therapy

When urokinase was withdrawn from the market, alternative thrombolytics such as alteplase and reteplase needed to be evaluated for peripheral vascular disease (PVD). The efficacy, safety, and cost of these agents were evaluated formally by the Department of Pharmacy and presented to the Pharmacy and Therapeutics Committee. No published data support a difference in efficacy or safety between these agents. A cost analysis estimated the average total cost of care was higher for patients treated with reteplase ($4,556) compared with alteplase ($2,139). Therefore, alteplase was determined to be a more cost-effective thrombolytic agent to treat PVD.