A model of cost-effectiveness of tissue plasminogen activator in patient subgroups 3 to 4.5 hours after onset of acute ischemic stroke.
A model of cost-effectiveness of tissue plasminogen activator in patient subgroups 3 to 4.5 hours after onset of acute ischemic stroke.
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DOI：
10.1016/j.annemergmed.2012.04.020
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发表时间：
2013-01
影响因子：
6.2
通讯作者：
Veenstra, David L.
中科院分区：
文献类型：
--
作者：
Boudreau, Denise M.;Guzauskas, Greg;Villa, Kathleen F.;Fagan, Susan C.;Veenstra, David L.
ECASS III 研究表明，与安慰剂相比，急性缺血性中风 (AIS) 后 3-4.5 小时给予重组组织纤溶酶原激活剂 (rtPA) 可改善患者残疾。根据患者临床和人口统计因素，评估 AIS 发病后 3-4.5 小时给予 rtPA 与不治疗的长期增量成本效益。我们开发了一种基于疾病的决策分析模型，从付款人的角度预测 AIS 后患者的终生结果。临床数据来自 ECASS III 试验、纵向队列研究和健康状态偏好研究。成本数据基于医疗保险报销和其他已发布的来源。我们进行了概率敏感性分析来评估分析中的不确定性。与 100 名患者组成的假设队列相比，rtPA 延长了 7 年寿命（95% 可信范围 [CR]，0.05–17）和 24 个质量调整生命年（QALY）（95% CR，1–60），成本差异为 149,500 美元（95% CR，−463,700 – 610,000 美元）安慰剂。所有患者每获得 QALY 的增量成本效益比为 6,300 美元；对于<65岁的患者，节省费用； ≥ 65 岁，$35,800/QALY；对于基线 NIHSS 0-9 的患者，$16,300/QALY； 10-19，$37,500/QALY； ≥ 20，$2,400/QALY。除糖尿病和心房颤动外，大多数其他亚组（例如性别、中风病史和高血压病史）都是从成本节约到成本效益的。结果表明，3 至 4.5 小时治疗窗口内的 rtPA 可改善大多数患者亚组的长期患者预后，并且与不治疗相比具有良好的经济价值。
The ECASS III study showed that recombinant tissue plasminogen activator (rtPA) given 3–4.5 hours after acute ischemic stroke (AIS) led to improvement in patient disability versus placebo. To evaluate the long-term incremental cost-effectiveness of rtPA given 3–4.5 hours after AIS onset versus no treatment based on patient clinical and demographic factors. We developed a disease-based decision analytic model to project lifetime outcomes of patients post-AIS from the payer perspective. Clinical data were derived from the ECASS III trial, longitudinal cohort studies, and health state preference studies. Cost data were based on Medicare reimbursement and other published sources. We performed probabilistic sensitivity analyses to evaluate uncertainty in the analysis. rtPA in a hypothetical cohort of 100 patients resulted in a gain of 7 years of life (95% credible range [CR], 0.05–17) and 24 quality-adjusted life-years (QALYs) (95% CR, 1–60), and a difference in cost of $149,500 (95% CR, −$463,700 – $610,000) compared with placebo. The incremental cost-effectiveness ratio for all patients was $6,300 per QALY gained; for patients <65 years old, cost saving; ≥ 65 years old, $35,800/QALY; for patients with baseline NIHSS 0–9, $16,300/QALY; 10–19, $37,500/QALY; ≥ 20, $2,400/QALY. The majority of other subgroups such as gender, history of stroke, and history of hypertension were cost-saving to cost-effective with the exceptions of diabetes and atrial fibrillation. The results indicate that rtPA in the 3- to 4.5-hour therapeutic window provides improvement in long-term patient outcomes in most patient subgroups and is a good economic value versus no treatment.
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影响因子：
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作者：
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通讯作者：
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