Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset.

2021-11

Muntendorf, Louisa-Kristin

Konnopka, Alexander

König, Hans-Helmut

Boutitie, Florent

Ebinger, Martin

Endres, Matthias

Fiebach, Jochen B

Thijs, Vincent N

Lemmens, Robin

Muir, Keith W

Nighoghossian, Norbert

Pedraza, Salvador

Simonsen, Claus Z

Gerloff, Christian

Thomalla, Götz

cost-effectiveness

magnetic resonance imaging

quality-adjusted life-year

thrombolysis

tissue-type plasminogen activator

Journal Article

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10.1016/j.jval.2021.05.005

Patients waking up with stroke symptoms are often excluded from intravenous thrombolysis with alteplase (IV-tpa). The WAKE-UP trial, a European multicenter randomized controlled trial, proved the clinical effectiveness of magnetic resonance imaging-guided IV-tpa for these patients. This analysis aimed to assess the cost-effectiveness of the intervention compared to placebo. A Markov model was designed to analyze the cost-effectiveness over a 25-year time horizon. The model consisted of an inpatient acute care phase and a rest-of-life phase. Health states were defined by the modified Rankin Scale (mRS). Initial transition probabilities to mRS scores were based on WAKE-UP data and health state utilities on literature search. Costs were based on data from the University Medical Center Hamburg-Eppendorf, literature, and expert opinion. Incremental costs and effects over the patients' lifetime were estimated. The analysis was conducted from a formal German healthcare perspective. Univariate and probabilistic sensitivity analyses were performed. Treatment with IV-tpa resulted in cost savings of €51 009 and 1.30 incremental gains in quality-adjusted life-years at a 5% discount rate. Univariate sensitivity analysis revealed incremental cost-effectiveness ratio being sensitive to the relative risk of favorable outcome on mRS for placebo patients after stroke, the costs of long-term care for patients with mRS 4, and patient age at initial stroke event. In all cases, IV-tpa remained cost-effective. Probabilistic sensitivity analysis proved IV-tpa cost-effective in >95% of the simulations results. Magnetic resonance imaging-guided IV-tpa compared to placebo is cost-effective in patients with ischemic stroke with unknown time of onset.

link

Value in Health :The journal of the International Society for Pharmacoeconomics and Outcomes Research 2021; 24(11): 1620-1627

Value in Health