HEALTH ECONOMIC EVALUATION OF INTRAVENOUS THROMBOLYTIC TREATMENT WITHIN 3 HOURS AND BETWEEN 3 AND 5 HOURS AFTER ONSET OF ACUTE ISCHEMIC STROKE

Purpose: Stroke is a major cause of mortality and severe disability, which result in substantial burden to the healthcare system. Intravenous thrombolysis with alteplase (rt-PA) given within the first few hours of onset of symptoms, is one of the promising treatments for acute ischemic stroke, though there is still discussion about the associated magnitude of risks, cost and benefits. Moreover, to our knowledge, no economic analysis of thrombolysis given between 3 and 5 hours after stroke onset has been established. The aim of this study was to assess the cost-effectiveness of intravenous thrombolytic treatment (within 3 hours and between 3 and 5 hours after symptom onset) compared with traditional therapy in patients with acute ischemic stroke.  

Methods: Analyses were done in NorCaD, a Markov-model based on Norwegian incidence data and treatment costs. The model was run on data for 70-year-old men with average risk for further cardiovascular diseases. The patients were followed until death or 100 years of age. Effectiveness of the strategies was based on meta-analyses of published RCTs identified by a systematic search. Quality of life data were extracted from published literature. The model calculated quality-adjusted life years (QALYs) with different strategies and life time costs related to stroke. We also analysed data for women and other age groups. In addition, we performed sensitivity analyses to get an impression on uncertainty surrounding our analyses.  

Results: Thrombolysis given within 3 hours provided 0.13 additional QALYs and reduced lifetime costs for the health care system with USD 76,279 compared with traditional treatment. Hence, Thrombolytic treatment given within 3 hours after stroke is a dominant strategy. Thrombolysis given between 3 and 5 hours resulted in a loss in QALYs of 0.16 compared to traditional treatment. Thombolysis also reduced costs, resulting in a cost-effectiveness of USD 401.000 per QALY gained. Hence, assuming a willingness to pay per QALY of USD 77,000 (NOK 500,000), trombolysis given 3 to 5 hours was cost-effective compared with traditional treatment. Sensitivity analyses showed the cost per QALY gained was dependent on the health effect estimate and drug costs. The results also showed little sensitivity with gender and age variation.  

Conclusion: Thrombolytic therapy given within 3 hours and between 3 and 5 hours after stroke onset are cost-effective relative to traditional therapy.