Budget Impact Analysis: Alteplase for Stroke Treatment in Argentina

OBJECTIVES: Stroke is the leading cause of disability and the fourth cause of death in Argentina. The treatment with Alteplase is clinically proven with a high level of evidence. However, there is no local data about the cost-effectiveness of Alteplase in Argentina.

The objective is to evaluate the cost of ischemic stroke (IS), showing a budget impact analysis of alteplase treatment.

METHODS: The budget impact model compares a base scenario with a 1,2% thrombolysis rate with Alteplase in IS (Arenas registry) and two hypothetical scenarios (8% and 16% thrombolysis rate). The evolution of patients was estimated using validated models, including modified Rankin Scale to estimate resources of rehabilitation. The cost analysis only includes direct healthcare costs associated with IS (services, medications and supplies), alteplase cost and rehabilitation for only the first twelve months at April 2023 values, expressed in US dollars (US$) at official exchange rate. Indirect costs and rehabilitation costs beyond the first year were excluded.

The study population was determined based on IS Argentine incidence, considering public and private healthcare systems to determine differential costs.

RESULTS: An estimation of 39.190 IS patients was used according to incidence rate 84/100.000 for IS adjusted to Argentine population (Estepa Registry). Of these, 62,1% have health insurance, while the remaining has exclusive public coverage.

The base scenario of 1,2% had a total expenditure of US$ 871.688.065 during the first year. With 8% scenario was US$ 869.989.798 (US$ -1.689.267), and with 16% it descends to US$ 867.991.838 (US$ -3.696.227). The savings were mainly due to the decrease in rehabilitation resources among the population receiving Alteplase.

CONCLUSIONS: The use of Alteplase has proven to be a cost-saving strategy. The economic benefit of using intravenous thrombolytics could potentially be higher if indirect costs and time horizon beyond first year were considered.