Abstract
Objective: While the clinical effect of rhTNK-tPA in STEMI treatment has been established, the economic effect of adopting the new therapy (rh-TNK-tPA) is still unclear. The present study aimed to examine the cost-effectiveness of rhTNK-tPA compared with rt-PA in the Chinese setting. Methods: A Markov model was constructed to conduct the cost-effectiveness analysis from a third-party payer perspective. Costs of PCI, rehabilitation after discharge, CABG, myocardial ischemia recurrence, cardiac shock, reinfarction, and adverse events were considered. Clinical effectiveness data were obtained from the pivotal phase II clinical trial. Sensitivity analyses were conducted to examine the robustness of the base-case findings. Results: The total cost of treatment for the 30 days after STEMI onset in the rhTNK-tPA and rt-PA arms were ¥30,846 and ¥31,314, respectively. The QALYs of rhTNK-tPA and rt- PA arms were 0.0345 and 0.0343 respectively. RhTNK-tPA was dominant. The total cost of lifetime in the rhTNK-tPA and rt-PA arms were ¥134,519 and ¥134,311, respectively. The corresponding QALYs in the rhTNK-tPA and rt-PA arms were 6.397 and 6.356, respectively. The ICER of rhTNK-tPA vs. rt-PA treatment was ¥5,020/QALY. The sensitivity analyses showed that rhTNK-tPA was dominant in most scenarios. Conclusions: RhTNK-tPA therapy is cost-saving and more effective compared with rt-PA for STEMI treatment in the Chinese population.
Highlights
Introduction andBackground(STEMI is one of the two types of acute myocardial infarction MI), defined by characteristic symptoms of MI in association with persistent electrocardiographic (ECG) ST-elevation and subsequent release of biomarkers of myocardial necrosis [1,2,3]
The sensitivity analyses showed that rhTNK-tissue plasminogen activator (tPA) was dominant in most scenarios
RhTNK-tPA therapy is cost-saving and more effective compared with rt-PA for ST-Elevation Myocardial Infarction (STEMI) treatment in the Chinese population
Summary
(STEMI is one of the two types of acute myocardial infarction MI), defined by characteristic symptoms of MI in association with persistent electrocardiographic (ECG) ST-elevation and subsequent release of biomarkers of myocardial necrosis [1,2,3]. The incidence of AMI ranks fourth in all cardiovascular diseases (Cardiovascular disease report 2015 of China) [4]. According to a recent study by Chinese Centre for Disease Control and Prevention (CCDC), the incidence of AMI among Chinese adults was 0.44 [5] and 0.54‰for urban Chinese adults [5]. The mortality of AMI has been increasing rapidly in China in recent years. In 2014, it was 55.32 per 100,000 residents in urban areas and 68.6 per 100,000 residents in rural areas [5]. The World Bank estimated that MI and stroke would account for more than 50%
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