Cost-Effectiveness of Thrombolysis Within 4.5 Hours of Acute Ischemic Stroke in China

Abstract

Objectives: Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. This study aims to determine the cost-effectiveness of tPA treatment in China setting. Methods: A combination of a decision tree and a Markov model was developed to determine the cost-effectiveness of tPA treatment versus no tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China) study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted lifeyears (QALYs) were compared both in short term (2 years) and in long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. Results: Comparing to no tPA treatment, tPA treatment within 4.5 hours has a gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460), yielding an incremental cost-effectiveness ratio (ICER) of CNY 94,300 (US$ 14,500) per QALY gained after 2 years, and a lifetime gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000), yielding an ICER of CNY 15,500 (US$ 2,380) per QALY gained. Probabilistic sensitivity analysis shows that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200) per QALY. Conclusions: Intravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic stroke in China setting.