title: Cost-effectiveness of tissue-type plasminogen activator in the 3- to 4.5-hour time window for acute ischemic stroke.
abstract: OBJECTIVE
  The aim of this study was to determine the cost-effectiveness of tissue-type plasminogen activator (tPA) treatment in the 3- to 4.5-hour time window after ischemic stroke.
  
  
  METHODS
  Decision-analytic and Markov state-transition models were created to determine the cost-effectiveness of treatment of ischemic stroke patients with intravenous tPA administered in the 3- to 4.5-hour time window compared with medical therapy without tPA. Health benefits were measured in quality-adjusted life-years (QALYs). The economic outcome measure of the model was the difference in estimated healthcare costs between the 2 treatment alternatives. The incremental cost-effectiveness ratio was calculated by dividing the cost difference by the difference in QALYs. One-way sensitivity and probabilistic analyses were performed to test the robustness of the model.
  
  
  RESULTS
  The administration of tPA compared with standard medical therapy resulted in a lifetime gain of 0.28 QALYs for an additional cost of $6050, yielding an incremental cost-effectiveness ratio of $21 978 per QALY. One-way sensitivity analyses demonstrated that the incremental cost-effectiveness ratio was most sensitive to the cost of hospitalization for patients who received tPA. Based on probabilistic analysis, there is an 88% probability that tPA is the preferred treatment at a willingness-to-pay threshold of $50 000 per QALY.
  
  
  CONCLUSIONS
  The balance of costs and benefits favors treatment with intravenous tPA in the 3- to 4.5-hour time window. This supports, from a societal perspective, the use of tPA therapy in this treatment time window for acute ischemic stroke.
authors: Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, California 94305-5235, USA. cetung@stanford.edu
authors: Christie E
authors: CE
authors: Tung
authors: Sandra S
authors: SS
authors: Win
authors: Maarten G
authors: MG
authors: Lansberg
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005343:Fibrinolytic Agents / Q000191:economics* / Q000627:therapeutic use; D017048:Health Care Costs; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics; D019057:Quality-Adjusted Life Years; D020521:Stroke / Q000188:drug therapy*; D015912:Thrombolytic Therapy / Q000191:economics*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000191:economics* / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator