Cost-Utility Analysis of Tissue Plasminogen Activator Therapy for Acute Ischaemic Stroke: A Canadian Healthcare Perspective
Shannon E. Sinclair
Peter S. Loewen
Susan C. Fagan
Carlo A. Marra
Background: There are over 40 000 ischaemic strokes annually in Canada, which result in significant morbidity, mortality and burden to the healthcare system. A recent, large clinical trial has evaluated tissue plasminogen activator (t-PA) intravenously for the treatment of acute ischaemic stroke with promising outcomes but with an increased risk of symptomatic intracranial haemorrhage. Objective: To compare clinical and economic outcomes of intravenous t-PA therapy (0.9 mg/kg, to a maximum of 90mg, initiated within 3 hours of stroke onset) versus no t-PA for acute ischaemic stroke based on the outcomes achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial. Design: A Markov model depicting the natural lifetime course after an initial acute ischaemic stroke. On the basis of this model, a simulated trial compared no t-PA with t-PA. Patients: A hypothetical cohort of 1000 patients with acute ischaemic stroke. Study perspective: Canadian healthcare system. Outcome measures: Total acute stroke and post-stroke treatment costs and cumulative quality-adjusted life-years (QALYs). Results: For a hypothetical cohort of 1000 patients, the estimated lifetime stroke costs were 103 100 000 Canadian dollars ($Can) [1999 values) in the t-PA arm ($Can103 100 per patient) compared with $Can106 900 000 in the no t-PA arm ($Can106 900 per patient), yielding a lifetime cost difference of $Can3 800 000 in favour of t-PA versus no t-PA ($Can3800 per patient). In the hypothetical cohort, t-PA treatment resulted in 13 130 QALYs versus 9670 QALYs with no t-PA treatment. This translated into a net benefit of 3460 additional QALYs per 1000 patients (3.46 QALYs per patient). No treatment, outcome or economic variables influenced the model outcome. Conclusion: From the standpoint of cost effectiveness, treatment of acute ischaemic stroke with intravenous t-PA is an economically attractive strategy.
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