Year-end Sale % OFF 
Abstract
BackgroundPrevious economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country.MethodsA combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China) study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted life-years (QALYs) were compared in both short term (2 years) and long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results.ResultsComparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460), yielding an incremental cost-effectiveness ratio (ICER) of CNY 94,300 (US$ 14,500) per QALY gained in 2 years; and to a long-term gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000), yielding an ICER of CNY 15,500 (US$ 2,380) per QALY gained in 30 years. Probabilistic sensitivity analysis showed that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200) per QALY.ConclusionsIntravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic strokes in China.
Highlights
Stroke accounts for 301 million disability-adjusted life-years, making it the first leading cause of death and imposing significant disease and economic burden in China [1]
For a 63-year-old patient with acute ischemic stroke, type plasminogen activator (tPA) treatment would be cost-ineffective in the first year, but become cost-effective from the second year onwards, using the threshold of Chinese Yuan Renminbi (CNY) 105,000 (3x GDP per capita of China in 2011, US 16,200) as the willingness-to-pay per quality-adjusted life-years (QALYs)
If odds ratio of favorable functional outcome at day 90 within 1.5–3 hours increased to 2.40 from 1.12, the incremental cost-effectiveness ratio (ICER) of tPA treatment would drop to CNY 9.653/QALY from CNY 40,667/ QALY
Summary
Stroke accounts for 301 million disability-adjusted life-years, making it the first leading cause of death and imposing significant disease and economic burden in China [1]. Economic studies conducted in North America, Europe and Australia showed tPA given within 4.5 hours is cost-effective or even cost-saving in the long term [7,8,9,10,11,12,13,14,15]. All of these studies were conducted in developed countries; the findings from these countries may not be relevant in developing countries due to their differences in demographics, healthcare systems and payment coverage. Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
