Cost-effectiveness of ancrod treatment of acute ischaemic stroke: results from the Stroke Treatment with Ancrod Trial (STAT).
OBJECTIVE
This paper describes a recent randomized controlled trial in which 42% of patients receiving ancrod attained a favourable outcome in comparison with 34% of controls. Although the above effect size corresponds to a number needed to treat (to achieve a favourable outcome) of approximately 13, intuition does not necessarily suggest what would be the overall impact of a treatment with this level of efficacy.


METHODS
The objective was to evaluate the cost-effectiveness of ancrod. Cost-effectiveness analysis of data from the Stroke Treatment with Ancrod Trial (STAT) trial was carried out. The participants were 495 patients with data on functional status at the conclusion of follow-up. Short-term results were based upon utilization and quality of life observed during the trial; these were merged with expected long-term results obtained through simulation using the Stroke Policy Model. The main outcome measure was incremental cost-effectiveness ratio.


RESULTS
Ancrod treatment resulted in both better quality-adjusted life expectancy and lower medical costs than placebo as supported by sensitivity analysis. The cost differential was primarily attributable to the long-term implications of ancrod's role in reducing disability.


CONCLUSIONS
If ancrod is even modestly effective, it will probably be cost-effective (and, indeed, cost-saving) as well. The net population-level impact of even modestly effective stroke treatments can be substantial.
Samsa
Gregory P
GP
Center for Clinical Health Policy Research, Suite 230, Duke University, 2200 West Main Street, Durham, NC 27705, USA. samsa001@mc.duke.edu
Matchar
David B
DB
Williams
G Rhys
GR
Levy
David E
DE
D000328:Adult; D000721:Ancrod / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D017059:Models, Econometric; D019057:Quality-Adjusted Life Years; D012306:Risk; D020521:Stroke / Q000188:drug therapy*; D000071939:Stroke Rehabilitation
D005343:Fibrinolytic Agents; D000721:Ancrod