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

Yuesong Pan, Qidong Chen, Xingquan Zhao, Xiaoling Liao, Chunjuan Wang, Wanliang Du, Gaifen Liu, Liping Liu, Chunxue Wang, Yilong Wang, Yongjun Wang and for the TIMS-CHINA Investigators

PLOS ONE, 2014, vol. 9, issue 10, 1-8

Abstract: Background: Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country. Methods: A combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of 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 life-years (QALYs) were compared in both short term (2 years) and long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. Results: Comparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term 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 in 2 years; and to a long-term 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 in 30 years. Probabilistic sensitivity analysis showed 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 strokes in China.

Date: 2014
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0110525

DOI: 10.1371/journal.pone.0110525

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