Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke.
OBJECTIVE
The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging.


METHODS
A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature.


RESULTS
The calculated cost-effectiveness ratio after the first year was $55,591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises.


CONCLUSIONS
A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.
Ehlers
Lars
L
HTA Unit, Aarhus University Hospital, Olof Palmes Allé 17, 8200 Aarhus N, Denmark. le@ag.aaa.dk
Andersen
Grethe
G
Clausen
Lone Beltoft
LB
Bech
Merete
M
Kjølby
Mette
M
D000208:Acute Disease; D002545:Brain Ischemia / Q000175:diagnosis / Q000188:drug therapy*; D002985:Clinical Protocols / Q000592:standards; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D003718:Denmark; D005343:Fibrinolytic Agents / Q000191:economics / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging / Q000191:economics / Q000706:statistics & numerical data; D008390:Markov Chains; D017059:Models, Econometric; D009010:Monte Carlo Method; D018579:Patient Selection; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000592:standards; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000175:diagnosis / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000191:economics*; D013995:Time; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator