Cost-effectiveness of tissue-type plasminogen activator in the 3- to 4.5-hour time window for acute ischemic stroke.
Cost-effectiveness of tissue-type plasminogen activator in the 3- to 4.5-hour time window for acute ischemic stroke.
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DOI：
10.1161/strokeaha.111.615682
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发表时间：
2011-08
期刊：
影响因子：
8.3
通讯作者：
Lansberg MG
中科院分区：
文献类型：
--
作者：
Tung CE;Win SS;Lansberg MG
本研究的目的是确定缺血性卒中后3至4.5小时时间窗内tPA治疗的成本效益。建立决策分析和马尔可夫状态转换模型，以确定与不使用tPA的药物治疗相比，在3至4.5小时的时间窗内静脉注射tPA治疗缺血性卒中患者的成本效益。健康效益以质量调整生命年（QHMS）衡量。该模型的经济结果指标是两种治疗方案之间估计的医疗费用差异。增量成本-效果比（ICER）的计算方法是将成本差异除以QELS差异。进行了单向敏感性和概率分析，以测试模型的稳健性。给予tPA超过标准药物治疗导致终身收益0.28 QALY，额外费用为6，050美元，ICER为21，978美元/QALY。单向敏感性分析表明，ICER对接受tPA治疗的患者的住院费用最敏感。基于概率分析，在每个QALY 50，000美元的支付意愿阈值下，tPA是首选治疗的概率为88%。成本和获益的平衡有利于在3 - 4.5小时时间窗内进行静脉tPA治疗。从社会角度来看，这支持在急性缺血性卒中的治疗时间窗内使用tPA治疗。
The aim of this study was to determine the cost-effectiveness of tPA treatment in the 3 to 4.5 hour time-window after ischemic stroke. Decision-analytic and Markov state-transition models were created to determine the cost-effectiveness of treatment of ischemic stroke patients with intravenous tPA administered in the 3 to 4.5 hour time-window compared with medical therapy without tPA. Health benefits were measured in quality-adjusted life-years (QALYs). The economic outcome measure of the model was the difference in estimated healthcare costs between the two treatment alternatives. The incremental cost-effectiveness ratio (ICER) was calculated by dividing the cost difference by the difference in QALYs. One-way sensitivity and probabilistic analyses were performed to test the robustness of the model. The administration of tPA over standard medical therapy resulted in a lifetime gain of 0.28 QALYs for an additional cost of $6,050, yielding an ICER of $21,978 per QALY. One-way sensitivity analyses demonstrated that the ICER was most sensitive to the cost of hospitalization for patients who received tPA. Based on probabilistic analysis there is 88% probability that tPA is the preferred treatment at a willingness to pay threshold of $50,000 per QALY. The balance of costs and benefits favors treatment with intravenous tPA in the 3 to 4.5 hour time-window. This supports, from a societal perspective, the use of tPA therapy in this treatment time-window for acute ischemic stroke.