A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischemic stroke

Details

• Alternative Title:
  Stroke Vasc Neurol
• Personal Author:
  Joo, Heesoo ; Wang, Guijing ; George, Mary G.
• Description:
  Background
  
  Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed.
  
  Aims
  
  To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times.
  
  Summary of review
  
  A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the key words acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving, and incremental cost-effectiveness analysis. The review is limited to original research articles published during 1995–2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0–3 hours after stroke onset, 2 studies within 3–4.5 hours, 3 studies within 0–4.5 hours, and 2 study within 0–6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0–3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3–4.5 hours after stroke increased costs but still was cost-effective.
  
  Conclusions
  
  The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.
  
  
• Subjects:
  Cost-Benefit Analysis Cost Savings Drug Costs Fibrinolytic Agents Humans Infusions, Intravenous Ischemic Stroke Quality-Adjusted Life Years Quality Of Life Thrombolytic Therapy Time-to-Treatment Time Factors Tissue Plasminogen Activator Treatment Outcome

  More +
• Source:
  Stroke Vasc Neurol. 2(2):73-83
• Pubmed ID:
  28736623
• Pubmed Central ID:
  PMC5516524
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  2
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8545b0f4fd06d14194722881ea15deafc9027c90e329b6546f8fe9b32cf2723f
• Download URL:
  https://stacks.cdc.gov/view/cdc/47526/cdc_47526_DS1.pdf
• File Type:
  [PDF - 801.54 KB ]