Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients

Elizabeth Parody-Rua, Alejandro Bustamante, Joan Montaner, Maria Rubio-Valera, David Serrano, Soledad Pérez-Sánchez, Alba Sánchez-Viñas, César Guevara-Cuellar and Antoni Serrano-Blanco ()
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Elizabeth Parody-Rua: Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu
Alejandro Bustamante: Stroke Unit, Hospital Universitari Germans Trias i Pujol
Joan Montaner: Vall d’Hebron Institute of Research (VHIR)
Maria Rubio-Valera: Head of Quality and Patient Safety, Parc Sanitari Sant Joan de Déu. Institut de Recerca Sant Joan de Déu
David Serrano: Freelance Health Economist
Soledad Pérez-Sánchez: IBiS/Hospital Universitario Virgen del Rocío/CSIC/University of Seville and Department of Neurology, Hospital Universitario Virgen Macarena
Alba Sánchez-Viñas: Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu
César Guevara-Cuellar: Universidad Icesi
Antoni Serrano-Blanco: CIBER of Epidemiology and Public Health (CIBERESP)

The European Journal of Health Economics, 2023, vol. 24, issue 4, No 10, 632 pages

Abstract: Abstract Objectives Stroke treatment with intravenous tissue-type plasminogen activator (tPA) is effective and efficient, but as its benefits are highly time dependent, it is essential to treat the patient promptly after symptom onset. This study evaluates the cost-effectiveness of a blood biomarker test to differentiate ischemic and hemorrhagic stroke to guide pre-hospital treatment with tPA in patients with suspected stroke, compared with standard hospital management. The standard care for patients suffering stroke consists mainly in diagnosis, treatment, hospitalization and monitoring. Methods A Markov model was built with four health states according to the modified Rankin scale, in adult patients with suspected moderate to severe stroke (NIHSS 4-22) within 4.5 hours after symptom onset. A Spanish Health System perspective was used. The time horizon was 15 years. Quality-adjusted life-years (QALYs) and life-years gained (LYGs) were used as a measure of effectiveness. Short- and long-term direct health costs were included. Costs were expressed in Euros (2022). A discount rate of 3% was used. Probabilistic sensitivity analysis and several one-way sensitivity analyses were conducted. Results The use of a blood-test biomarker compared with standard care was associated with more QALYs (4.87 vs. 4.77), more LYGs (7.18 vs. 7.07), and greater costs (12,807€ vs. 12,713€). The ICER was 881€/QALY. Probabilistic sensitivity analysis showed that the biomarker test was cost-effective in 82% of iterations using a threshold of 24,000€/QALY. Conclusions The use of a blood biomarker test to guide pre-hospital thrombolysis is cost-effective compared with standard hospital care in patients with ischemic stroke.

Keywords: Stroke; Biomarkers; tPA; Cost-effectiveness (search for similar items in EconPapers)
Date: 2023
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DOI: 10.1007/s10198-022-01495-1

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