Analysis of the cost-effectiveness of thrombolysis with alteplase in stroke.
BACKGROUND
The cerebrovascular accident (CVA) or stroke is the main cause of death in Brazil and little information is available on the cost of treatment.


OBJECTIVE
To carry out a cost-effectiveness analysis of thrombolysis in stroke, up to three hours after symptom onset, comparing the treatment with alteplase versus the conservative treatment, under the perspective of the Brazilian Public Health System (SUS).


METHODS
A decision analysis model was developed to compare the two types of treatment. Cycles were considered, during which the patients would go through five stages of disability post-stroke, based on the modified Rankin scale. The probability to present intracranial hemorrhage in the first year was obtained from the NINDS trial. For the subsequent years, one-year cycles were considered to calculate patients' mortality. The outcome was expressed as quality-adjusted life years (QALY). Both direct and indirect costs were considered in the analysis. Costs and outcomes were discounted at 5% a year.


RESULTS
In the first year, the QALY gained was 0.06 for both sexes, with an incremental cost of R$ 2,558 for men and R$ 2,312 for women. The incremental cost-effectiveness ratio (ICER) in one year was R$ 40,539 / QALY (USD 28,956) for men and R$ 36,640 / QALY (USD 26,171) for women. After the second year, the treatment with alteplase reduced the cost of treatment (Purchasing Power Parity index: US$ 1 = R$ 1.4).


CONCLUSIONS
The thrombolytic therapy with alteplase within the first three hours following a stroke is cost-effective in the Brazilian Public Health System scenario.
Araújo
Denizar Vianna
DV
Universidade do Estado do Rio de Janeiro. denizar@cardiol.br
Teich
Vanessa
V
Passos
Roberta Benitez Freitas
RB
Martins
Sheila Cristina Ouriques
SC
D000368:Aged; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004180:Direct Service Costs; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D012737:Sex Factors; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000191:economics*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator