Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke

Abstract

Background and Purpose-Previous economic studies outside Australia have demonstrated that patients treated with tissuetype 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.

A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischaemic stroke

“…Among 15 original articles reviewed, six studies were from the US(9, 24–28), two from the United Kingdom (UK)(29, 30), two from Australia(31, 32), two from China(33, 34), and one each from Canada(35), New Zealand(36), Denmark(37), and Spain(38). Nine of them used the payers’ perspective or health care system perspective, and four studies used the societal perspective while two studies did not clearly mention it.…”

One, Two, Three Steps Toward Cell Therapy for Stroke

“…Despite knowledge of its pathology, treatment currently is limited to only one Food and Drug Administration (FDA) approved drug, tPA, with a therapeutic window of only up to 4.5 hours following stroke onset. 1–5 This therapy is effective for few stroke victims due to this narrow window and with serious adverse effects (i.e., hemorrhagic bleeding) when tPA is administered beyond this time frame. 5–7 As a result, stroke remains a major cause of disability and death, imposing the need for novel treatments.…”

“…1–5 This therapy is effective for few stroke victims due to this narrow window and with serious adverse effects (i.e., hemorrhagic bleeding) when tPA is administered beyond this time frame. 5–7 As a result, stroke remains a major cause of disability and death, imposing the need for novel treatments. In laboratory studies, stem cell therapy has proven to be a potential method of regenerating the injured brain beyond the acute phase of stroke.…”

“…13–16 These cells are postulated to assist in cell replacement and/or secrete factors which assist in the proliferation and survival of remaining, at-risk cells. 1–5,8–12,17–18 In view of many positive laboratory studies subsequently failing in the clinic, coupled with increasing amount of research involving stem cell therapy, the need for guidelines on standardizing laboratory and clinical procedures has been considered as a translational approach to enhance the successful outcome of cell therapy for stroke in the clinic. The Stem cell Therapies as an Emerging Paradigm in Stroke (STEPS) brought together leaders in stem cell research, industry, and regulatory agencies to create these standards and to provide direction for future research.…”

Future Directions for Intra-Arterial Therapy for Acute Ischaemic Stroke: Is There Life after Three Negative Randomized Controlled Studies

“…IA thrombolysis is associated with an increase in acute care costs of USD 15,000 per patient [17]. However, while IV tPA is potentially harmful and not always effective it is a cost-effective treatment, allowing for an incremental cost-effectiveness ratio ranging from USD 1,478 to 21,978 for each 1.0 quality-adjusted life year (QALY) [18,19]. The average procedural cost associated with stent retriever devices (including the Solitaire device) is approximately USD 16,022 (p = 0.0002) [20].…”