Abstract W MP107: An Updated Cost-Effectiveness Analysis of r-tPA for Acute Ischemic Stroke Treated Within 3 Hours of Symptom Onset
Background: A recently completed meta-analysis by Wardlaw and colleagues, including the results of the IST-3 trial, provides more precise estimates of the efficacy and safety of r-tPA in the treatment of acute ischemic stroke (AIS) within 3 hours of symptom onset. No economic analyses have been conducted for r-tPA in the 0-3 hour treatment timeframe since 1998, and changing healthcare costs and better estimates of long-term disposition offer an opportunity to reassess the value of r-tPA in AIS.
Objective: To evaluate the cost-effectiveness of r-tPA within 3 hours of symptom onset compared to no r-tPA among patients with AIS using updated efficacy, safety, and healthcare cost data.
Methods: A Markov decision model compared r-tPA treatment within 3 hours of symptom onset vs. no treatment in a hypothetical cohort of r-tPA-eligible AIS patients. Key model inputs (efficacy, safety, and mortality associated with each health state parameter) were varied based on the NINDS and ECASS III clinical trials and a recent meta-analysis of all trials, including the newly published IST-3 trial. Patients with modified Rankin scores of 0-1, 2-5, and 6 were classified into health states of non-disabled, disabled, or dead, respectively. Costs and utilities (patient preferences) associated with each health state were derived from the literature. The primary outcomes were incremental quality-adjusted life years (QALYs) gained and lifetime healthcare costs from a payer perspective.
Results: Treatment with r-tPA was associated with increased QALYs between 0.14 and 0.46. The cost-effectiveness results ranged from a cost savings of $2700 to $25,000 per QALY gained in a worst-case scenario. Major drivers of results were efficacy, cost of r-tPA, disabled patient mortality, disabled patient quality of life, and risk of recurrent stroke.
Conclusion: Economic analyses based on current clinical and cost data suggest that r-tPA is highly cost effective in the treatment of AIS across numerous efficacy, safety, and mortality estimates. Further research on differences in long-term mortality in disabled and non-disabled patients will refine these estimates.
Author Disclosures: D. Boudreau: Other Research Support; Significant; Genentech, Inc. G.F. Guzauskas: Other Research Support; Significant; Genentech, Inc. E. Chen: Employment; Significant; Genentech, Inc. D. Tayama: Employment; Significant; Genentech, Inc. S. Fagan: Consultant/Advisory Board; Significant; Pfizer, Inc., Genentech, Inc. D.L. Veenstra: Other Research Support; Significant; Genentech, Inc..
- © 2014 by American Heart Association, Inc.