Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke

Fagan, Susan C.; Morgenstern, Lewis B.; Petitta, Antonio; Ward, Richard E.; Tilley, Barbara C.; Marler, John R.; Levine, Steven R.; Broderick, Joseph P.; Kwiatkowski, Thomas; Frankel, Michael; Brott, Thomas G.; Walker, Michael D.

doi:10.1212/wnl.50.4.883

Cited by 348 publications

(331 citation statements)

References 14 publications

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“…The conversion of the Ranking scale levels into a quality of life index was obtained according to the results of previous studies done by Fagan et al [20] and Pinto et al [21]. Scale level 0 was converted to 0.9, scale level 1 was converted to 0.68, scale level 2 was converted to 0.47, scale level 3 was converted to 0.2, scale level 4 was converted to 0.07, scale level 6 was converted to 0 and scale level 5 was converted to −0.02.…”

Section: Health Benefitsmentioning

confidence: 99%

Hypothesis testing by simulation of a medical study model using the expected net benefits criteria

Abbas¹,

Rovira²,

Casanovas³

2013

Health

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Introduction: This work investigates whether to conduct a medical study from the point of view of the expected net benefit taking into account statistical power, time and cost. The hypothesis of this paper is that the expected net benefit is equal to zero. Methods: Information were obtained from a pilot medical study that investigates the effects of two diagnostic modalities, magnetic resonance imaging (MRI) and computerized axial tomography scanner (CT), on patients with acute stroke. Statistical procedure was applied for planning and contrasting equivalence, noninferiority and inequality hypotheses of the study for the effectiveness, health benefits and costs. A statistical simulation model was applied to test the hypothesis that conducting the study would or not result in overall net benefits. If the null hypothesis not rejected, no benefits would occurred and therefore the two arms-patterns of diagnostic and treatment are of equal net benefits. If the null hypothesis is rejected, net benefits would occur if patients are diagnosed with the more favourable diagnostic modality. Results: For any hypothesis design, the expected net benefits are in the range of 366 to 1796 per patient at 80% of statistical power if conducting the study. The power depends on the monetary value available for a unit of health improvement. Conclusion: The statistical simulations suggest that diagnosing patients with CT will provide more favourable health outcomes showing statistically significant expected net benefits in comparison with MRI.

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Section: Health Benefitsmentioning

confidence: 99%

Hypothesis testing by simulation of a medical study model using the expected net benefits criteria

Abbas¹,

Rovira²,

Casanovas³

2013

Health

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“…When studied in the North American healthcare system, thrombolysis was shown to be cost saving due to the reduction in rehabilitation and nursing home costs. 48 The only study conducted into the cost efficiency of thrombolysis use in the NHS, 49 however, concluded that although the benefits appeared promising, the estimates of effectiveness and cost effectiveness were imprecise. This imprecision resulted in a huge variability in outcomes, ranging from large cost savings under favourable assumptions to large expenditures using less favourable estimates.…”

Section: Cost Effectivenessmentioning

confidence: 99%

What is the place of thrombolysis in acute stroke? A review of the literature and a current perspective

2008

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-The global burden of stroke, the undisputed success of intravenous thrombolysis in the management of myocardial infarction and subsequent evidence from animal models of cerebral infarction have all fuelled intense interest in the potential role for thrombolytic agents in the acute management of stroke in clinical practice. Before any clinical treatment is introduced universally its safety and efficacy must be demonstrated in the routine clinical environment and not just within the ideal conditions of controlled clinical trials. Similarly, the cost effectiveness of a new treatment modality is an essential consideration before its use is promulgated. This paper reviews the current scientific evidence for thrombolysis in stroke with reference to issues of safety, efficacy and cost effectiveness.KEY WORDS: cerebral haemorrhage, cerebral infarction, cost effectiveness, stroke, thrombolysis, tissue plasminogen activator IntroductionIntravenous (iv) thrombolytic agents are an established and effective treatment in acute myocardial infarction (AMI), a disease with some similarities to acute ischaemic stroke. Additionally there have been several animal stroke models, which demonstrate that thrombolysis results in reduced infarct size and improved neurological function. 1-3 These findings have provided a rationale to implement the use of thrombolysis in the management of human acute ischaemic stroke. Its use has, however, been delayed due to concerns over increased risk of intracerebral haemorrhage and the cost of providing an infrastructure capable of providing this treatment in an acute setting.To justify the use of a treatment it must be shown to be safe, effective (under the ideal conditions of a randomised controlled trial (RCT) and in the community) and economically efficient. This article reviews the evidence for the use of thrombolysis in acute ischaemic stroke and poses the question as to whether its widespread use is justified. Randomised controlled trialsAs of July 2007, there were eight major RCTs studying the safety (indicated by the early death or haemorrhage rate) and efficacy (using the end-points of death or dependency at the end of the trial follow-up period) of iv thrombolytic therapy. Table 1 summarises this data and includes figures for a large Cochrane meta-analysis. 4 The aim of this paper is not to provide an exhaustive review of all the trials conducted into the safety and efficacy of thrombolysis and so seven trials included in the Cochrane review have been omitted. Three of the trials were conducted during the 1980s (Ohtomo 1985, 5 Atarashi 1985 Abe 1981 7 ) and were methodologically different to the others -very low doses of urokinase were given over several days, starting 5-14 days after the stroke. In addition, functional data was not recordedmerely rates of haemorrhage and death by end of follow up. The four other trials omitted from the table (Japanese Thrombolysis Study Group 1993, 8 Mori 1992, 9 Haley 1993, 10 Morris 1995 11 ) were small studies with only 98, 31, 27 and 20 pat...

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“…Cost-effectiveness studies concerning primary 4 and secondary prevention 5 , diagnostic testing 6 , thrombolysis [7][8][9][10][11][12][13][14][15] , rehabilitation 16 , management systems 17 and also the informal care costs of long-term care after stroke 18,19 have been published. Few studies have explored the cost-effectiveness of mechanical thrombectomy [20][21][22] .…”

Section: Introductionmentioning

confidence: 99%

The Cost of Materials for Intra-Arterial Thrombectomy

et al. 2013

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This paper reports the cost of endovascular materials used for the treatment of large-vessel ischemic stroke in the anterior circulation according to the angiographic score and clinical results at three months. From November 2009 to July 2011, 57 ischemic patients (mean age, 64.6 ±13.8 years) with anterior large vessel occlusion were included. Mean National Institutes of Health Stroke Scale (NIHSS) on admission was 18.4 ± 4.9. Mean duration of symptoms until the arterial puncture was 207±67 minutes. Recanalization was assessed using the Thrombolysis In Myocardial Infarction (TIMI) score. Patient selection was performed on a non-enhanced CT scanner. According to the TIMI final angiographic score and the modified Rankin score (mRS) at three months, we determined the cost of the material used. Complete (n=12, TIMI grade 3) or partial perfusion (n=35, TIMI grade 2) was achieved in 47 (82.5%) lesions. At three months, 33.3% (n=19) had a mRS score ≤ 2. The mean cost of the material used in the operative room was 5018±2402 euro. Intra-arterial thrombolysis presents a substantial initial cost and the long-term economic impact has to be evaluated. Our health system has to take the price of these new technologies into account for future medical choices and urgently evaluate them in randomized controlled trials.

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Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke

Cited by 348 publications

References 14 publications

Hypothesis testing by simulation of a medical study model using the expected net benefits criteria

Hypothesis testing by simulation of a medical study model using the expected net benefits criteria

What is the place of thrombolysis in acute stroke? A review of the literature and a current perspective

The Cost of Materials for Intra-Arterial Thrombectomy

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