Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke
Cost-effectiveness of intravenous thrombolysis with alteplase within a 3-hour window after acute ischemic stroke
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DOI：
10.1161/01.str.0000251790.19419.a8
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发表时间：
2007-01-01
期刊：
影响因子：
8.3
通讯作者：
Kjolby, Mette
中科院分区：
文献类型：
--
作者：
Ehlers, Lars;Andersen, Grethe;Kjolby, Mette
背景和目的：本研究的目的是评估阿替普酶（Actilyse）静脉溶栓治疗急性缺血性卒中的成本和成本效益，并采用24小时神经内科覆盖和磁共振成像。方法：设计卫生经济模型，计算1。2年、3年和30年。效应数据来自6项阿替普酶溶栓治疗的大规模随机和安慰剂对照研究的荟萃分析。费用数据来自丹麦奥胡斯医院的溶栓治疗。以及之前发表的文献。结果：第一年后计算的成本-效果比为每质量调整生命年（基准情况）55 591美元。第二年之后，成本-效果比的计算表明溶栓具有成本效益。长期计算（30年）表明，在模型前提下，与保守治疗相比，溶栓是一种优势策略。结论：与保守治疗相比，高质量的24小时神经内科覆盖和磁共振成像溶栓治疗在短期内可能不具有成本效益。从长远来看，有可能节省大规模的卫生经济成本。
Background and Purpose-The aim of this study was to assess the costs and cost-effectiveness of intravenous thrombolysis treatment with alteplase (Actilyse) of acute ischemic stroke with 24-hour in-house neurology coverage and use of magnetic resonance, imaging.Methods-A health economic model was designed to calculate the marginal cost-effectiveness ratios for time spans of 1. 2, 3 and 30 years. Effect data were extracted from a meta-analysis of six large-scale randomized and placebo-controlled studies of thrombolytic therapy with alteplase. Cost data were extracted from thrombolysis treatment at Aarhus Hospital, Denmark. and from previously published literature.Results-The calculated cost-effectiveness ratio after the first year was $55 591 US per quality-adjusted life-year (base case). After the second year, computation of the cost-effectiveness ratio showed that thrombolysis was cost-effective. The long-term computations (30 years) showed that thrombolysis was a dominant strategy compared with conservative treatment given the model premises.Conclusions-A high-quality thrombolysis treatment with 24-hour in-house neurology coverage and magnetic resonance imaging might not be cost-effective in the short term compared with conservative treatment. In the long term, there are potentially large-scale health economic cost savings.