Cost-effectiveness analysis of thrombolytic treatment for stroke.
OBJECTIVE
Thrombolysis is used to treat stroke patients based on the National Institute of Neurological Disorders and Stroke study and meta-analysis results. We present a cost-effectiveness analysis based on a probabilistic model of the use of thrombolytic therapy in stroke treatment.


METHODS
We surveyed patients who had had a stroke during their hospital stay and examined them again 1 year after release from the hospital to obtain data on costs and natural history. We then calculated utility weights using the European Quality of Life Questionnaire. When the model runs, 4,000 Monte Carlo simulations are undertaken in which each parameter value changes depending on its probability distribution. The results are expressed in terms of the cost-effectiveness plane and the cost-effectiveness acceptability curve.


RESULTS
We studied 435 patients, of whom 304 had had an ischemic stroke. One year later, 216 were still alive. The mean utility values were 0.22 for disabled patients and 0.77 for autonomous patients. The incremental cost-effectiveness ratio (ICER) obtained by means of the parameters was -19,000 EUR/quality-adjusted life year, reflecting a saving of 6,000 EUR and a health benefit for patients. The cost-effectiveness plane showed that thrombolysis was a dominant variable in 96.1% of simulations. In the acceptability curves, only 0.4 of simulations obtained an ICER higher than the societal threshold.


CONCLUSIONS
Thrombolytic therapy seems to be a useful intervention because it is inexpensive and cost-effective. The key factor is the decreased rate of disability, which results in a better quality of life of the patient and lower costs.
Mar
Javier
J
Clinical Management Unit, Hospital Alto Deba, Mondragón, Spain. jmar@hmon.osakidetza.net
Begiristain
Jose Maria
JM
Arrazola
Arantza
A
D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008390:Markov Chains; D018803:Models, Economic; D020521:Stroke / Q000188:drug therapy* / Q000191:economics* / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000191:economics*; D010959:Tissue Plasminogen Activator / Q000191:economics* / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator