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Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke: Experience From Australian Stroke Center.
MedLine Citation:
PMID:  23780955     Owner:  NLM     Status:  Publisher    
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.
Sharman P Tan Tanny; Lucy Busija; Danny Liew; Sarah Teo; Stephen M Davis; Bernard Yan
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-18
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-19     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
From the Melbourne Brain Centre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia (S.P.T.T., L.B., S.T., S.M.D., B.Y.); and Department of Medicine (S.P.T.T., L.B., D.L., S.T., S.M.D., B.Y.), Melbourne EpiCentre (L.B., D.L.), University of Melbourne and Melbourne Health, Melbourne, Victoria Australia.
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