Cost-Effectiveness Analysis of Tenecteplase vs. Alteplase for Adults With Acute Ischemic Stroke (AIS) in Greece
Author(s)
Kyriakos Souliotis, PhD1, CHRISTINA GOLNA, LLM, MSc2, Pavlos Golnas, MSc2, Giannis Papageorgiou, MBA3, Nikos Nikas, PharmD3, Christos Smyrnaios, MSc3, Georgios Tsivgoulis, MD, PhD, MSc, FESO, FEAN, FAAN4.
1School of Social and Political Sciences, University of Peloponnese, Corinth, Greece, 2Health Policy Institute, Maroussi, Greece, 3Boehringer Ingelheim Hellas, Athens, Greece, 42nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
1School of Social and Political Sciences, University of Peloponnese, Corinth, Greece, 2Health Policy Institute, Maroussi, Greece, 3Boehringer Ingelheim Hellas, Athens, Greece, 42nd Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
OBJECTIVES: To evaluate the cost-effectiveness of tenecteplase versus alteplase in Acute Ischaemic Stroke (AIS) patients who are eligible for intravenous thrombolysis in Greece from the perspective of the third-party payer, namely the National Organization for Healthcare Services Provision (EOPYY).
METHODS: A Markov decision-analytic model prepared for the healthcare system in the UK was localized to the health care setting in Greece to compare tenecteplase versus alteplase in the treatment of AIS. The time horizon was configured to span a lifetime duration (26 years) with an annual discount rate of 3.5% for benefits and costs. In the base case, treatment efficacy and quality of life (QoL) data were sourced from the AcT trial. Costs included drug acquisition, disease management, and adverse events, at 2024 Euros. Health benefits were measured in Life Years (LYs) gained and Quality-Adjusted Life Years (QALYs) gained. Incremental cost-effectiveness ratios (ICERs) were calculated at a willingness-to-pay threshold of € 54,855/QALY. Scenario and sensitivity analyses explored parameter uncertainty.
RESULTS: Treatment with tenecteplase for a 1000-patient population cohort at a lifetime horizon from the perspective of EOPYY resulted in an additional 44.7 LYs and 22.251 QALYs at an incremental cost of €478,843. The ICER was calculated at €10,039/LY gained and €21,520/QALY gained, rendering tenecteplase a highly cost-effective option compared to alteplase. In a scenario analysis, where clinical and QoL data were sourced from both the AcT trial and real-world evidence, tenecteplase remained cost-effective with an ICER of €15,896/QALY gained compared with alteplase. Deterministic and probabilistic sensitivity analyses confirmed robustness of results, in both scenarios.
CONCLUSIONS: Treatment with tenecteplase in AIS patients who are eligible for thrombolysis offers additional LYs and QALYs compared to alteplase at a lifetime horizon and is highly cost-effective from the perspective of the third-party payer.
METHODS: A Markov decision-analytic model prepared for the healthcare system in the UK was localized to the health care setting in Greece to compare tenecteplase versus alteplase in the treatment of AIS. The time horizon was configured to span a lifetime duration (26 years) with an annual discount rate of 3.5% for benefits and costs. In the base case, treatment efficacy and quality of life (QoL) data were sourced from the AcT trial. Costs included drug acquisition, disease management, and adverse events, at 2024 Euros. Health benefits were measured in Life Years (LYs) gained and Quality-Adjusted Life Years (QALYs) gained. Incremental cost-effectiveness ratios (ICERs) were calculated at a willingness-to-pay threshold of € 54,855/QALY. Scenario and sensitivity analyses explored parameter uncertainty.
RESULTS: Treatment with tenecteplase for a 1000-patient population cohort at a lifetime horizon from the perspective of EOPYY resulted in an additional 44.7 LYs and 22.251 QALYs at an incremental cost of €478,843. The ICER was calculated at €10,039/LY gained and €21,520/QALY gained, rendering tenecteplase a highly cost-effective option compared to alteplase. In a scenario analysis, where clinical and QoL data were sourced from both the AcT trial and real-world evidence, tenecteplase remained cost-effective with an ICER of €15,896/QALY gained compared with alteplase. Deterministic and probabilistic sensitivity analyses confirmed robustness of results, in both scenarios.
CONCLUSIONS: Treatment with tenecteplase in AIS patients who are eligible for thrombolysis offers additional LYs and QALYs compared to alteplase at a lifetime horizon and is highly cost-effective from the perspective of the third-party payer.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE164
Topic
Clinical Outcomes, Economic Evaluation, Health Technology Assessment
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory)