Cost-Utility Analysis of Tissue Plasminogen Activator Therapy for Acute Ischaemic Stroke

Sinclair, Shannon E.; Frighetto, Luciana; Loewen, Peter; Sunderji, Rubina; Teal, Philip; Fagan, Susan C.; Marra, Carlo A.

doi:10.2165/00019053-200119090-00004

Cited by 65 publications

(74 citation statements)

References 21 publications

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“…13,18 Within the 3-hour time window, studies have estimated a decrease in health expenditure by AUD $2669 during 1-year time-horizon 19 to AUD $3654 during a 30-year time-horizon. 26 Because tPA administration was also associated with health gain, it was considered a dominant strategy (less costly and more effective), and hence, ICERs were not calculated. These included 1 Australian study by Mihalopoulos et al, 19 but because this had been based on 1994 data, results may no longer be applicable.…”

Section: Discussionmentioning

confidence: 99%

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

Tanny

Busija

Liew

et al. 2013

Stroke

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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.

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Section: Discussionmentioning

confidence: 99%

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

Tanny

Busija

Liew

et al. 2013

Stroke

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“…10,11,15 Such studies have been the basis for many important cost-effectiveness analyses for stroke prevention and treatment modalities. [16][17][18] Childhood stroke cost data, however, are limited: there has been one published US cost analysis from a single children's hospital. 19 The costs of neonatal stroke have yet to be addressed.…”

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confidence: 99%

The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort

et al. 2010

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“…19 Also using NINDS data, Sinclair reported a savings estimate of $3800 CAD:1999 per tPA-treated patient over a lifetime (maximum 30 years). 20 These models produced absolute estimates based on trial data for patients treated <3 hours without considering relative service performance differences or the impact of prehospital identification. By applying pooled trial data for treatment up to 6 hours to a detailed model using an NHS perspective, Sandercock suggested that compared with standard care, there was a 78% probability of a gain in quality-adjusted survival during the first year with an incremental cost per additional QALY gained of £13 581 (GBP:price year not stated).…”

Section: Discussionmentioning

confidence: 99%

Modelling the Efficiency of Local Versus Central Provision of Intravenous Thrombolysis After Acute Ischemic Stroke

McMeekin

Gray

Ford

et al. 2013

Stroke

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Background and Purpose-Prehospital redirection of stroke patients to a regional center is used as a strategy to maximize the provision of intravenous thrombolysis. We developed a model to quantify the benefit of redirection away from local services that were already providing thrombolysis. Methods-A microsimulation using hospital and ambulance data from consecutive emergency admissions to 10 local acute stroke units estimated the effect of redirection to 2 regional neuroscience centers. Modeled outcomes reflected additional journey time and accuracy of stroke identification in the prehospital phase, and the relative efficiency of patient selection and door-needle time for each local site compared with the nearest regional neuroscience center. Results-Thrombolysis was received by 223/1884 emergency admissions. Based on observed site performance, 68 additional patients would have been treated after theoretical redirection of 1269 true positive cases and 363 stroke mimics to the neuroscience center. Over 5 years redirection of this cohort generated 12.6 quality-adjusted life years at a marginal cost of £6730 ($10 320, €8347). The average additional cost of a quality-adjusted life year gain was £534 ($819, €673). Conclusions-Under these specific circumstances, redirection would have improved outcomes from thrombolysis at little additional cost. (Stroke. 2013;44:3114-3119.)

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Cost-Utility Analysis of Tissue Plasminogen Activator Therapy for Acute Ischaemic Stroke

Abstract: From the standpoint of cost effectiveness, treatment of acute ischaemic stroke with intravenous t-PA is an economically attractive strategy.

Cited by 65 publications

References 21 publications

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

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

The 5-year direct medical cost of neonatal and childhood stroke in a population-based cohort

Modelling the Efficiency of Local Versus Central Provision of Intravenous Thrombolysis After Acute Ischemic Stroke

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