Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset

Nov 1, 2021, 00:00
10.1016/j.jval.2021.05.005
https://www.valueinhealthjournal.com/article/S1098-3015(21)01579-5/fulltext
Title : Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(21)01579-5&doi=10.1016/j.jval.2021.05.005
First page : 1620
Section Title : ECONOMIC EVALUATION
Open access? : No
Section Order : 1620

Objectives

Patients waking up with stroke symptoms are often excluded from intravenous thrombolysis with alteplase (IV-tpa). The WAKE-UP trial, a European multicenter randomized controlled trial, proved the clinical effectiveness of magnetic resonance imaging-guided IV-tpa for these patients. This analysis aimed to assess the cost-effectiveness of the intervention compared to placebo.

Methods

A Markov model was designed to analyze the cost-effectiveness over a 25-year time horizon. The model consisted of an inpatient acute care phase and a rest-of-life phase. Health states were defined by the modified Rankin Scale (mRS). Initial transition probabilities to mRS scores were based on WAKE-UP data and health state utilities on literature search. Costs were based on data from the University Medical Center Hamburg-Eppendorf, literature, and expert opinion. Incremental costs and effects over the patients’ lifetime were estimated. The analysis was conducted from a formal German healthcare perspective. Univariate and probabilistic sensitivity analyses were performed.

Results

Treatment with IV-tpa resulted in cost savings of €51 009 and 1.30 incremental gains in quality-adjusted life-years at a 5% discount rate. Univariate sensitivity analysis revealed incremental cost-effectiveness ratio being sensitive to the relative risk of favorable outcome on mRS for placebo patients after stroke, the costs of long-term care for patients with mRS 4, and patient age at initial stroke event. In all cases, IV-tpa remained cost-effective. Probabilistic sensitivity analysis proved IV-tpa cost-effective in >95% of the simulations results.

Conclusions

Magnetic resonance imaging-guided IV-tpa compared to placebo is cost-effective in patients with ischemic stroke with unknown time of onset.

Categories :
  • Cardiovascular Disorders
  • Cost-comparison, Effectiveness, Utility, Benefit Analysis
  • Economic Evaluation
  • Methodological & Statistical Research
  • Modeling and simulation
  • Specific Diseases & Conditions
Tags :
  • cost-effectiveness
  • magnetic resonance imaging
  • quality-adjusted life-year
  • thrombolysis
  • tissue-type plasminogen activator
Regions :
  • Western Europe
ViH Article Tags :