title: Cost-Effectiveness of Intra-Arterial Treatment as an Adjunct to Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke.
abstract: OBJECTIVE
  The objective of this study was to determine the cost-effectiveness of intra-arterial treatment within the 0- to 6-hour window after intravenous tissue-type plasminogen activator within 0- to 4.5-hour compared with intravenous tissue-type plasminogen activator alone, in the US setting and from a social perspective.
  
  
  METHODS
  A decision analytic model estimated the lifetime costs and outcomes associated with the additional benefit of intra-arterial therapy compared with standard treatment with intravenous tissue-type plasminogen activator alone. Model inputs were obtained from published literature, the Multicenter Randomized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherlands (MR CLEAN) study, and claims databases in the United States. Health outcomes were measured in quality-adjusted life years (QALYs). Treatment benefit was assessed by calculating the cost per QALY gained. One-way and probabilistic sensitivity analyses were performed to estimate the overall uncertainty of model results.
  
  
  RESULTS
  The addition of intra-arterial therapy compared with standard treatment alone yielded a lifetime gain of 0.7 QALY for an additional cost of $9911, which resulted in a cost of $14 137 per QALY. Multivariable sensitivity analysis predicted cost-effectiveness (≤$50 000 per QALY) in 97.6% of simulation runs.
  
  
  CONCLUSIONS
  Intra-arterial treatment after intravenous tissue-type plasminogen activator for patients with anterior circulation strokes within the 6-hour window is likely cost-effective. From a societal perspective, increased investment in access to intra-arterial treatment for acute stroke may be justified.
authors.affiliation: From the Departments of Neurology (M.H.L., J.R.S.) and Pharmacy (J.D.C.), University of Colorado, Aurora; and Stroke Program, University of Michigan, Ann Arbor (J.F.B.). Michelle.Leppert@ucdenver.edu.
authors.forename: Michelle H
authors.initials: MH
authors.lastname: Leppert
authors.affiliation: From the Departments of Neurology (M.H.L., J.R.S.) and Pharmacy (J.D.C.), University of Colorado, Aurora; and Stroke Program, University of Michigan, Ann Arbor (J.F.B.).
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Campbell
authors.affiliation: From the Departments of Neurology (M.H.L., J.R.S.) and Pharmacy (J.D.C.), University of Colorado, Aurora; and Stroke Program, University of Michigan, Ann Arbor (J.F.B.).
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Simpson
authors.affiliation: From the Departments of Neurology (M.H.L., J.R.S.) and Pharmacy (J.D.C.), University of Colorado, Aurora; and Stroke Program, University of Michigan, Ann Arbor (J.F.B.).
authors.forename: James F
authors.initials: JF
authors.lastname: Burke
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial / Q000379:methods; D007262:Infusions, Intravenous; D008297:Male; D020521:Stroke / Q000188:drug therapy* / Q000191:economics*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000191:economics*
chemical_list: D010959:Tissue Plasminogen Activator
keywords: cost effectiveness; stroke; tissue-type plasminogen activator