title: Cost-effectiveness of thrombolysis within 4.5 hours of acute ischemic stroke: experience from Australian stroke center.
abstract: OBJECTIVE
  Previous economic studies outside Australia have demonstrated that patients treated with tissue-type plasminogen activator (tPA) within 4.5 hours of stroke onset have lower healthcare costs than those not. We aim to perform cost-effectiveness analysis of intravenous tPA in an Australian setting.
  
  
  METHODS
  Data on clinical outcomes and costs were derived for 378 patients who received intravenous tPA within 4.5 hours of stroke onset at Royal Melbourne Hospital (Australia) between January 2003 and December 2011. To simulate clinical outcomes and costs for a hypothetical control group assumed not to have received tPA, we applied efficacy data from a meta-analysis of randomized trials to outcomes observed in the tPA group. During a 1-year time-horizon, net costs, years of life lived, and quality-adjusted life-years were compared and incremental cost-effectiveness ratios derived for tPA versus no tPA.
  
  
  RESULTS
  In the study population, mean (SD) age was 68.2 (13.5) years and 206 (54.5%) were men. Median National Institutes of Health Stroke Scale score (interquartile range) at presentation was 12.5 (8-18). Compared with no tPA, we estimated that tPA would result in 0.02 life-years and 0.04 quality-adjusted life-years saved per person>1 year. The net cost of tPA was AUD $55.61 per patient. The incremental cost-effectiveness ratios were AUD $2377 per life-year saved and AUD $1478 per quality-adjusted life-years saved. Because the costs of tPA are incurred only once, the incremental cost-effectiveness ratios would decrease with increasing time-horizon. Uncertainty analyses indicated the results to be robust.
  
  
  CONCLUSIONS
  Intravenous tPA within 4.5 hours represents a cost-effective intervention for acute ischemic stroke.
authors.affiliation: Melbourne Brain Centre, University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia.
authors.forename: Sharman P
authors.initials: SP
authors.lastname: Tan Tanny
authors.forename: Lucy
authors.initials: L
authors.lastname: Busija
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.forename: Sarah
authors.initials: S
authors.lastname: Teo
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000188:drug therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000191:economics*; D017721:Hospital Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000191:economics; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000188:drug therapy / Q000191:economics; D015912:Thrombolytic Therapy / Q000191:economics*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000191:economics*; D014739:Victoria
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
keywords: cost-benefit analysis; stroke; stroke, acute; thrombolytic therapy; tissue-type plasminogen activator