This presentation is part of: Poster Session - CEA: Methods and Applications; Health Services Research
COST-EFFECTIVENESS ANALYSIS OF THROMBOLYTIC TREATMENT FOR STROKE
Javier Mar, MD1, Jose M Begiristain, MD2, and Arantza Arrazola, MD2. (1) Alto Deba Hospital, Clinical Managment Unit, Mondragon, Spain, (2) Basque Government, Health Department, San Sebastian, Spain
Purpose: The treatment of acute stroke has generally been limited to the maintenance of vital functions and the avoidance of complications. Thrombolysis, prompted on the success of in the treatment of the acute myocardial infarction, has also been applied to stroke. The assessment of the NINDS trial a year after the event showed that the intravenous r-TPA decreased the disability by 30% without significant changes in mortality. This article presents a cost-effectiveness analysis, based upon a probabilistic model, of the use of thrombolytic therapy in stroke treatment. Methods: We carried out a survey with stroke patients during the hospital stay and a year after release from the hospital to obtain data on costs and natural history. We then calculated utility weights, using Euroquol-5D. Efficacy data were obtained from the NINDS trial. Every time the model runs, 4,000 Monte Carlo simulations are undertaken in which each parameter value changes depending on its probability distribution. The incremental cost-effectiveness ratio (ICER) is calculated for each simulation based on the incremental cost and incremental effectiveness. The results are expressed in terms of the cost-effectiveness plane, the CE acceptability curve and the Expected Value of Perfect Information (EVPI). Results: We studied 435 patients from whom 304 were ischemic strokes. One year later, 216 were alive and 78 were died. The mean utility values were 0.22 in disabled and 0.77 in autonomous patients. The ICER obtained with the means of the parameters is -19.000 €/AVAC reflecting a saving of 6.000 € and a health benefit for patients. The cost-effectiveness plane shows that thrombolysis is dominant in 96.1% of simulations. In the acceptability curves, only a 0.4 of simulations obtain an ICER higher than the societal threshold of 30,000 euros/QALY. The EVPI analysis showed that the total EVPI was low and that the utility values and the costs related with the disability were the parameters which influenced the results uncertainty. Conclusion: Thrombolytic therapy is judged an intervention to implement because saves cost and wins effectiveness. The key point is the decrease rate in patients disability what produces better quality of life and less costs. The uncertainty of the results was very small.
