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Title: Cost-Effectiveness of Tenecteplase Before Thrombectomy for Ischemic Stroke.
Austin Authors: Gao, Lan;Moodie, Marj;Mitchell, Peter J;Churilov, Leonid ;Kleinig, Timothy J;Yassi, Nawaf;Yan, Bernard;Parsons, Mark W;Donnan, Geoffrey A ;Davis, Stephen M;Campbell, Bruce C V
Affiliation: Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
Population Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia
Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia
Medicine (University of Melbourne)
Department of Neurology, Royal Adelaide Hospital, South Australia, Australia
Issue Date: Dec-2020 2020-10-07
Publication information: Stroke 2020; 51(12): 3681-3689
Abstract: Tenecteplase improved functional outcomes and reduced the requirement for endovascular thrombectomy in ischemic stroke patients with large vessel occlusion in the EXTEND-IA TNK randomized trial. We assessed the cost-effectiveness of tenecteplase versus alteplase in this trial. Post hoc within-trial economic analysis included costs of index emergency department and inpatient stroke hospitalization, rehabilitation/subacute care, and rehospitalization due to stroke within 90 days. Sources for cost included key study site complemented by published literature and government websites. Quality-adjusted life-years were estimated using utility scores derived from the modified Rankin Scale score at 90 days. Long-term modeled cost-effectiveness analysis used a Markov model with 7 health states corresponding to 7 modified Rankin Scale scores. Probabilistic sensitivity analyses were performed. Within the 202 patients in the randomized controlled trial, total cost was nonsignificantly lower in the tenecteplase-treated patients (40 997 Australian dollars [AUD]) compared with alteplase-treated patients (46 188 AUD) for the first 90 days(P=0.125). Tenecteplase was the dominant treatment strategy in the short term, with similar cost (5412 AUD [95% CI, -13 348 to 2523]; P=0.181) and higher benefits (0.099 quality-adjusted life-years [95% CI, 0.001-0.1967]; P=0.048), with a 97.4% probability of being cost-effective. In the long-term, tenecteplase was associated with less additional lifetime cost (96 357 versus 106 304 AUD) and greater benefits (quality-adjusted life-years, 7.77 versus 6.48), and had a 100% probability of being cost-effective. Both deterministic sensitivity analysis and probabilistic sensitivity analyses yielded similar results. Both within-trial and long-term economic analyses showed that tenecteplase was highly likely to be cost-effective for patients with acute stroke before thrombectomy. Recommending the use of tenecteplase over alteplase could lead to a cost saving to the healthcare system both in the short and long term. Registration: URL: Unique identifier: NCT02388061.
DOI: 10.1161/STROKEAHA.120.029666
Journal: Stroke
PubMed URL: 33023423
Type: Journal Article
Subjects: cost-benefit analysis
Appears in Collections:Journal articles

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