BACKGROUND AND PURPOSE: Previous economic studies outside Australia have demonstrated that patients treated with tissue-type plasminogen activator (tPA) within 4.5 hours of stroke onset have lower healthcare costs than those not. We aim to perform cost-effectiveness analysis of intravenous tPA in an Australian setting. METHODS: Data on clinical outcomes and costs were derived for 378 patients who received intravenous tPA within 4.5 hours of stroke onset at Royal Melbourne Hospital (Australia) between January 2003 and December 2011. To simulate clinical outcomes and costs for a hypothetical control group assumed not to have received tPA, we applied efficacy data from a meta-analysis of randomized trials to outcomes observed in the tPA group. During a 1-year time-horizon, net costs, years of life lived, and quality-adjusted life-years were compared and incremental cost-effectiveness ratios derived for tPA versus no tPA. RESULTS: In the study population, mean (SD) age was 68.2 (13.5) years and 206 (54.5%) were men. Median National Institutes of Health Stroke Scale score (interquartile range) at presentation was 12.5 (8-18). Compared with no tPA, we estimated that tPA would result in 0.02 life-years and 0.04 quality-adjusted life-years saved per person>1 year. The net cost of tPA was AUD $55.61 per patient. The incremental cost-effectiveness ratios were AUD $2377 per life-year saved and AUD $1478 per quality-adjusted life-years saved. Because the costs of tPA are incurred only once, the incremental cost-effectiveness ratios would decrease with increasing time-horizon. Uncertainty analyses indicated the results to be robust. CONCLUSIONS: Intravenous tPA within 4.5 hours represents a cost-effective intervention for acute ischemic stroke.
BACKGROUND AND PURPOSE: Previous economic studies outside Australia have demonstrated that patients treated with tissue-type plasminogen activator (tPA) within 4.5 hours of stroke onset have lower healthcare costs than those not. We aim to perform cost-effectiveness analysis of intravenous tPA in an Australian setting. METHODS: Data on clinical outcomes and costs were derived for 378 patients who received intravenous tPA within 4.5 hours of stroke onset at Royal Melbourne Hospital (Australia) between January 2003 and December 2011. To simulate clinical outcomes and costs for a hypothetical control group assumed not to have received tPA, we applied efficacy data from a meta-analysis of randomized trials to outcomes observed in the tPA group. During a 1-year time-horizon, net costs, years of life lived, and quality-adjusted life-years were compared and incremental cost-effectiveness ratios derived for tPA versus no tPA. RESULTS: In the study population, mean (SD) age was 68.2 (13.5) years and 206 (54.5%) were men. Median National Institutes of Health Stroke Scale score (interquartile range) at presentation was 12.5 (8-18). Compared with no tPA, we estimated that tPA would result in 0.02 life-years and 0.04 quality-adjusted life-years saved per person>1 year. The net cost of tPA was AUD $55.61 per patient. The incremental cost-effectiveness ratios were AUD $2377 per life-year saved and AUD $1478 per quality-adjusted life-years saved. Because the costs of tPA are incurred only once, the incremental cost-effectiveness ratios would decrease with increasing time-horizon. Uncertainty analyses indicated the results to be robust. CONCLUSIONS: Intravenous tPA within 4.5 hours represents a cost-effective intervention for acute ischemic stroke.
Authors: Silke Walter; Iris Q Grunwald; Stefan A Helwig; Andreas Ragoschke-Schumm; Michael Kettner; Mathias Fousse; Martin Lesmeister; Klaus Fassbender Journal: Curr Atheroscler Rep Date: 2018-08-29 Impact factor: 5.113
Authors: Naoki Tajiri; David M Quach; Yuji Kaneko; Stephanie Wu; David Lee; Tina Lam; Ken L Hayama; Thomas G Hazel; Karl Johe; Michael C Wu; Cesar V Borlongan Journal: PLoS One Date: 2014-03-10 Impact factor: 3.240
Authors: Bruce C V Campbell; Peter J Mitchell; Leonid Churilov; Mahsa Keshtkaran; Keun-Sik Hong; Timothy J Kleinig; Helen M Dewey; Nawaf Yassi; Bernard Yan; Richard J Dowling; Mark W Parsons; Teddy Y Wu; Mark Brooks; Marion A Simpson; Ferdinand Miteff; Christopher R Levi; Martin Krause; Timothy J Harrington; Kenneth C Faulder; Brendan S Steinfort; Timothy Ang; Rebecca Scroop; P Alan Barber; Ben McGuinness; Tissa Wijeratne; Thanh G Phan; Winston Chong; Ronil V Chandra; Christopher F Bladin; Henry Rice; Laetitia de Villiers; Henry Ma; Patricia M Desmond; Atte Meretoja; Dominique A Cadilhac; Geoffrey A Donnan; Stephen M Davis Journal: Front Neurol Date: 2017-12-14 Impact factor: 4.003