Abstract 136: Is the Use of r-tPa in Mild Stroke Patients Cost-Effective?
Background: The use of r-tPA in patients with moderate to severe stroke has been shown to be efficacious and cost-effective. However, nearly half of all ischemic strokes present with mild deficits (i.e. either persistently mild or rapidly improving stroke), and a third of untreated mild strokes result in significant disability. Small studies and post-hoc analyses of the recently completed IST-3 trial suggested r-tPA may reduce disability for mild stroke. If these preliminary clinical findings are verified, r-tPA in mild stroke patients may provide good economic value to healthcare systems.
Objective: To model the potential cost-effectiveness of r-tPA in the treatment of mild stroke in the US.
Methods: We developed a decision analytic model to simulate the outcomes of mild stroke patients treated vs. not treated with r-tPA. We modeled stroke severity health states based on modified Rankin scale (mRS) and Oxford handicap scale (OHS) scores using Markov techniques. Preliminary estimates of r-tPa effectiveness in patients suffering mild strokes were derived from a subset of IST-3 patients. Non-disabled patients were defined as having baseline NIHSS 0-15 who otherwise met all other standard three-hour r-tPA eligibility criteria. Healthcare costs, quality-adjusted life-years, and incremental cost-effectiveness were calculated, and scenario analyses were conducted to assess uncertainty.
Results: Treatment with r-tPA was estimated to lead to a 0.36 (range, 0.34 to 0.76) increase in quality-adjusted life years per patient treated, and cost-savings ranging from $871 to $5500. In widely varying scenario analyses, as long as r-tPA treatment resulted in a 2% absolute increase in the proportion of non-disabled patients, r-tPA was highly cost effective. The main drivers in the results were r-tPA effectiveness, healthcare costs for disabled patients, and quality-of-life for non-disabled patients.
Conclusion: Economic analyses based on preliminary clinical data suggest that r-tPA could be cost-saving or highly cost-effective in the treatment of mild patients. Controlled clinical trials will be valuable in definitively establishing the clinical and economic value of r-tPA in this patient population.
Author Disclosures: G.F. Guzauskas: Other Research Support; Significant; Genentech, Inc. E. Chen: Employment; Significant; Genentech, Inc. P. Khatri: Honoraria; Modest; Academic Grand Rounds (paid to Dept). Other; Modest; Taylor and Francis-Stroke Ctr Handbook book royalties (paid to Dept). Research Grant; Significant; NIH/NINDS (IMS III, NSTN NCC/RCC). Other Research Support; Significant; Significant; Genentech-PRISMS Trial PI (paid to Dept), Penumbra-THERAPY Trial PI (paid to Dept). P. Sandercock: Consultant/Advisory Board; Modest; Boehringer Ingelheim. D. Tayama: Employment; Significant; Genentech, Inc. D.L. Veenstra: Other Research Support; Significant; Genentech, Inc..
- © 2014 by American Heart Association, Inc.