title: Potential gains and costs from increasing access to thrombolysis for acute ischemic stroke patients in New Zealand hospitals.
abstract: OBJECTIVE
  Treatment of ischemic stroke patients with tissue-type plasminogen activator (tPA) is known to be effective and cost-effective, yet the percentage of patients treated with thrombolysis in hospitals remains low. The purpose of this study is to examine whether providing thrombolysis in New Zealand hospitals is currently cost-effective and to estimate the amount that might be spent on campaigns aimed at increasing thrombolysis receipt rates.
  
  
  METHODS
  A decision-analytic model was developed and populated using health services data from the literature and the Auckland Regional Community Stroke Outcome Study. The cost-utilities of providing thrombolysis over one-year and patient lifetime were estimated. Using a threshold of NZ$20 000 (US$15 337) per quality-adjusted life year, the analysis identified the maximum amount that might be spent on campaigns aiming to increase rates of receipt of thrombolysis above their current levels. Monte Carlo simulations and probabilistic sensitivity analysis explored the robustness of the findings.
  
  
  RESULTS
  Providing thrombolysis was cost-effective, especially when long-term costs and effects were considered (NZ$6641 or US$5093 per quality-adjusted life year). The results suggest that better management within hospitals would be more effective in increasing thrombolysis receipt rates (up to 17%) than campaigns aiming at higher awareness of stroke symptoms in the community. The amount that might be spent on a national campaign to increase rate of receipt of thrombolysis from its current level (3% of eligible patients) depended upon the effectiveness of the campaign, ranging from under NZ$6 million for New Zealand for an increase in rate to 30% to over $9 million for an increase in rate to 50%.
  
  
  CONCLUSIONS
  While thrombolysis is a cost-effective treatment in New Zealand, resources should be devoted to campaigns, both within hospitals and in the community, to increase coverage.
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Braden
authors.initials: B
authors.lastname: Te Ao
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.|School of Social Science, Humanities and Arts, University of California, Merced, CA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Brown
authors.affiliation: Department of Neurology, Canterbury District Health Board, Christchurch, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Fink
authors.affiliation: New Zealand Stroke Foundation, Wellington, New Zealand.
authors.forename: Mark
authors.initials: M
authors.lastname: Vivian
authors.affiliation: National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
authors.forename: Valery
authors.initials: V
authors.lastname: Feigin
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004469:Economics, Hospital; D006801:Humans; D009520:New Zealand; D011336:Probability; D020521:Stroke / Q000188:drug therapy* / Q000191:economics*; D015912:Thrombolytic Therapy / Q000191:economics*
keywords: costs and outcomes; mass campaigns; thrombolysis; tradeoffs