OBJECTIVES : Recombinant tissue plasminogen activator (r-tPA) is the most promising approach for the treatment of acute ischemic stroke up to 3-h after symptom onset. The present study aimed to evaluate the cost-utility of r-tPA in Iran.

METHODS

This is a cost-utility analysis from a patient perspective to compare IV r-tPA with standard medical therapy of ischemic stroke. A Markov model was developed to measure the cost-utility of r-tPA in Iranian patients with acute ischemic stroke. The costs and outcomes were analyzed for lifetime horizon from the patient perspective. 200 patients were selected from two major health centers in Iran. EQ-5D questionnaire was used to assess the quality of life in two groups of patients (r-tPA and no r-tPA). One-way and probabilistic sensitivity analyses were performed to test the robustness of the model.

RESULTS

The administration of r-tPA compared with standard medical therapy resulted in a lifetime gain of 0.56 QALYs for an additional cost of $1,326, yielding an incremental cost-effectiveness ratio of $2,363 per QALY which is below commonly accepted thresholds ($16,482) for cost-effectiveness in Iran.

CONCLUSIONS : The balance of costs and benefits favors treatment with r-tPA in the 3-hour time window.This supports, from a patient perspective, the use of r-tPA therapy in this treatment time window for acute ischemic stroke.