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Title: Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset.
Austin Authors: 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
Affiliation: Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Neurology, University Hospitals Leuven, Leuven, Belgium
Division of Experimental Neurology, Department of Neurosciences, KU Leuven, University of Leuven, Leuven, Belgium
Laboratory of Neurobiology, VIB-KU Leuven Center for Brain and Disease Research, Leuven, Belgium
Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
Zentrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin Berlin, Berlin, Germany; German Centre for Cardiovascular Research, Partner Site, Berlin, Germany
German Center for Neurodegenerative Diseases, Partner Site, Berlin, Germany
Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
The Florey Institute of Neuroscience and Mental Health
Hospices Civils de Lyon, Service de Biostatistique, Lyon, France..
Zentrum für Schlaganfallforschung Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, Scotland, UK
Department of Stroke Medicine, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
Department of Radiology, Dr Josep Trueta University Hospital, Institut d'Investigació Biomèdica de Girona, Girona, Italy
Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
Issue Date: Nov-2021
Date: 2021-07-31
Publication information: Value in Health :The journal of the International Society for Pharmacoeconomics and Outcomes Research 2021; 24(11): 1620-1627
Abstract: 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.
DOI: 10.1016/j.jval.2021.05.005
Journal: Value in Health
PubMed URL: 34711362
Type: Journal Article
Subjects: cost-effectiveness
magnetic resonance imaging
quality-adjusted life-year
tissue-type plasminogen activator
Appears in Collections:Journal articles

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