A Cost-Utility Analysis of Low-Dose vs Standard-Dose Intravenous Alteplase in the Management of Acute Non-Lacunar Ischaemic Strokes: A Perspective From the NHS

Speaker(s)

Okechukwu H1, Fazaldin Y2, Kanapathipillai D3, Shankar V3, Sohrabi Z3, Braniste A4, Mohammed Z5
1Imperial College London, London, UK, 2King's College London, London, Greater London, UK, 3Imperial College London, London, Greater London, UK, 4Lancaster University, Lancaster, Lancashire, UK, 5Leeds University, Leeds, Yorkshire, UK

Presentation Documents

OBJECTIVES: Studies exploring the efficacy and safety of low-dose (0.6 mg/kg) vs standard-dose (0.9mg/kg) intravenous alteplase in treating acute non-lacunar ischaemic strokes (aNLIS) have shown no significant difference in treatment effects, however, the risk of symptomatic intracerebral haemorrhage (ICH) is reduced with low dose alteplase. The aim of this study was to perform a cost-utility analysis (CUA) of low-dose and standard-dose intravenous alteplase in treating aNLIS.

METHODS: A systematic literature search was conducted on 09/02/22 to identify relevant clinical studies and economic evaluations. A CUA was then executed based on current literature. Costs were obtained from British National Formulary and NHS reference costs. Stroke severity was categorised using modified Rankin scores (mRS) and utility-weighted mRS was used to calculate Quality Adjusted Life Years (QALYs). A decision tree was also modelled to map outcomes of patients with acute ischaemic stroke based on data from the Zhou et al analysis of the ENCHANTED randomised trial.

RESULTS: The search yielded clinical studies with conflicting treatment success rates. 2/9 studies revealed lower 90-day functional independence (mRS 0-2) rates in low-dose groups, however 7/9 studies did not show significant differences, suggesting comparable efficacy. Safety outcomes, including ICH and 90-day mortality rates, were better with low-dose alteplase in 7/9 and 8/9 studies respectively. The calculated incremental cost-effectiveness ratio concluded that use of low-dose alteplase would save £62,875.38 for every QALY gained when compared to standard-dose alteplase. Benefits remained positive even when using a willingness-to-pay threshold of £20,000.

CONCLUSIONS: There is minimal difference between low-dose and standard-dose alteplase in terms of functional outcomes in aNLIS treatment. Low-dose alteplase results in lower procurement costs and potentially lower risk of ICH, making it a cost-effective alternative to standard practice. This is the first CUA directly comparing the two alternative doses from the perspective of the NHS, which aids in optimisation of resource allocation.

Code

EE619

Topic

Clinical Outcomes, Economic Evaluation, Health Policy & Regulatory, Study Approaches

Topic Subcategory

Comparative Effectiveness or Efficacy, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Literature Review & Synthesis, Public Spending & National Health Expenditures

Disease

Cardiovascular Disorders (including MI, Stroke, Circulatory), Drugs