Age-specific Cost Effectiveness of Using Intravenous Recombinant Tissue Plasminogen Activator for Treating Acute Ischemic Stroke

Details

• Alternative Title:
  Am J Prev Med
• Personal Author:
  Joo, Heesoo ; Wang, Guijing ; George, Mary G.
• Description:
  Introduction
  
  Studies have demonstrated that intravenous recombinant tissue plasminogen activator (IV rtPA) is a cost-effective treatment for acute ischemic stroke. Age-specific cost effectiveness has not been well examined. This study estimated age-specific incremental cost-effectiveness ratios (ICERs) of IV rtPA treatment versus no IV rtPA.
  
  Methods
  
  A Markov model was developed to examine the economic impact of IV rtPA over a 20-year time horizon on four age groups (18–44, 45–64, 65–80, and ≥81 years) from the U.S. healthcare sector perspective. The model used health outcomes from a national stroke registry adjusted by parameters from previous literature and current hospitalization costs in 2013 U.S. dollars. Long-term annual costs and quality-adjusted life years (QALYs) in the years after a stroke were discounted at 3% per year. Incremental costs, incremental QALYs, and ICERs were estimated and sensitivity analyses were conducted between 2015 and 2017.
  
  Results
  
  Use of IV rtPA gained 0.55 QALYs and cost $3,941 more than no IV rtPA for stroke patients aged ≥18 years over a 20-year time horizon. IV rtPA was a dominant strategy compared to no IV rtPA for patients aged 18–44 and 45–64 years. For patients aged 65–80 years, IV rtPA gained 0.44 QALYs and cost $4,872 more than no IV rtPA (ICER=$11,132/QALY). For patients aged ≥81 years, ICER was estimated at $48,676/QALY.
  
  Conclusions
  
  IV rtPA saved costs and improved health outcomes for patients aged 18–64 years and was cost effective for those aged ≥65 years. These findings support the use of IV rtPA.
  
  
• Keywords:
  Adult Aged Aged, 80 And Over Age Factors Brain Ischemia Cost-Benefit Analysis Female Fibrinolytic Agents Health Care Costs Hospitalization Humans Male Middle Aged Models, Economic Quality-Adjusted Life Years Recombinant Proteins Registries Stroke Tissue Plasminogen Activator Treatment Outcome United States Young Adult

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• Source:
  Am J Prev Med. 53(6 Suppl 2):S205-S212
• Pubmed ID:
  29153122
• Pubmed Central ID:
  PMC5819005
• Document Type:
  Journal Article
• Funding:
  CC999999/ImCDC/Intramural CDC HHSUnited States/ ; U36 OE000005/OE/OSELS CDC HHSUnited States/
• Volume:
  53
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7c81cb3c7fdae4847aa2be4d94a8c7def1b9d94a13fe4024bceee82a704ca0c0
• Download URL:
  https://stacks.cdc.gov/view/cdc/52030/cdc_52030_DS1.pdf
• File Type:
  [PDF - 378.75 KB ]