Presentation (CTI)

OBJECTIVES: To assess the cost-effectiveness of recombinant human TNK tissue-type plasminogen activator (rhTNK-tPA) compared to alteplase (rt-PA) for intravenous thrombolysis in acute ischemic stroke (AIS) patients within 4.5 hours of symptom onset, from the perspective of the healthcare system.
METHODS: A decision tree-Markov model was developed to estimate quality-adjusted life years (QALYs), direct medical costs, and incremental cost-effectiveness ratios (ICERs) for AIS patients receiving thrombolytic agent. The efficacy and safety data, drug costs, other direct medical expenses, and utility value data were sourced from TRACE Phase III clinical trial and literature databases. The model simulates a short term of one year and lifetime of 20 years results, with a cycle length of 3 months. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the robustness of the model.
RESULTS: This cost-effectiveness analysis demonstrated that the overall costs of 1 year are CNY 30 311 in rhTNK-tPA and CNY 34 679 in rt-PA with the same QALYs of 0.74 for both treatments. The lifetime costs for patients in the rhTNK-tPA and rt-PA groups were CNY 136 076 and CNY 148 355 respectively, with corresponding QALYs of 5.68 and 5.66. The rhTNK-tPA group generates lower treatment costs and better quality of life improvement, which thus could be considered a dominant alternative. One-way sensitivity analysis indicated that the proportion of mRS 1-2 and mRS 0 patients in both groups after treatment within 90 days were the most influential factors. PSA result revealed an 80% probability of rhTNK-tPA being cost-effective versus rt-PA at a willingness-to-pay threshold of one time the 2024 Chinese GDP per capita.
CONCLUSIONS: From the perspective of Chinese healthcare system, we conclude that compared to the rt-PA regimen, rhTNK-tPA is a cost-effective option for acute ischemic stroke patients.