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(Stroke. 2007;38:85.)
© 2007 American Heart Association, Inc.

Original Contributions

Cost-Effectiveness of Intravenous Thrombolysis With Alteplase Within a 3-Hour Window After Acute Ischemic Stroke

From the HTA Unit (L.E., M.B., M.K.), Aarhus University Hospital, Aarhus, Denmark; the Department of Neurology (G.A.) and the Planning Department (L.B.C.), Aarhus Hospital, Aarhus, Denmark.

Correspondence to Lars Ehlers, PhD, HTA Unit, Aarhus University Hospital, Olof Palmes Allé 17, 8200 Aarhus N, Denmark. E-mail: le{at}ag.aaa.dk

Background and Purpose— The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance imaging.

Methods— A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1, 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark, and from previously published literature.

Results— The calculated cost-effectiveness ratio after the first year was $55 591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises.

Conclusions— A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.

Key Words: acute care • economics • health policy • stroke • thrombolysis

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