Age-specific Cost Effectiveness of Using Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke

• Published in: American journal of preventive medicine Vol. 53; no. 6; pp. S205 - S212
• Main Authors: Joo, Heesoo, Wang, Guijing, George, Mary G.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-12-2017; Elsevier Science Ltd
• Subjects: Adult; Age differences; Age Factors; Aged; Aged, 80 and over; Brain Ischemia - drug therapy; Brain Ischemia - economics; Brain Ischemia - epidemiology; Cost analysis; Cost-Benefit Analysis; Economic impact; Female; Fibrinolytic Agents - economics; Fibrinolytic Agents - therapeutic use; Health Care Costs - statistics & numerical data; Health care expenditures; Health status; Hospitalization; Hospitalization - economics; Hospitalization - statistics & numerical data; Humans; Immunotherapy; Ischemia; Male; Medical treatment; Middle Aged; Models, Economic; Quality adjusted life years; Recombinant Proteins - economics; Recombinant Proteins - therapeutic use; Registries - statistics & numerical data; Stroke; Stroke - drug therapy; Stroke - economics; Stroke - epidemiology; Tissue Plasminogen Activator - economics; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; United States - epidemiology; Young Adult; United States > US
• ISSN: 0749-3797; 1873-2607
• DOI: 10.1016/j.amepre.2017.06.004

Studies have demonstrated that intravenous recombinant tissue plasminogen activator (IV rtPA) is a cost-effective treatment for acute ischemic stroke. Age-specific cost effectiveness has not been well examined. This study estimated age-specific incremental cost-effectiveness ratios (ICERs) of IV rtPA treatment versus no IV rtPA.
A Markov model was developed to examine the economic impact of IV rtPA over a 20-year time horizon on four age groups (18–44, 45–64, 65–80, and ≥81 years) from the U.S. healthcare sector perspective. The model used health outcomes from a national stroke registry adjusted by parameters from previous literature and current hospitalization costs in 2013 U.S. dollars. Long-term annual costs and quality-adjusted life years (QALYs) in the years after a stroke were discounted at 3% per year. Incremental costs, incremental QALYs, and ICERs were estimated and sensitivity analyses were conducted between 2015 and 2017.
Use of IV rtPA gained 0.55 QALYs and cost $3,941 more than no IV rtPA for stroke patients aged ≥18 years over a 20-year time horizon. IV rtPA was a dominant strategy compared to no IV rtPA for patients aged 18–44 and 45–64 years. For patients aged 65–80 years, IV rtPA gained 0.44 QALYs and cost $4,872 more than no IV rtPA (ICER=$11,132/QALY). For patients aged ≥81 years, ICER was estimated at $48,676/QALY.
IV rtPA saved costs and improved health outcomes for patients aged 18–64 years and was cost effective for those aged ≥65 years. These findings support the use of IV rtPA.