Journal
STROKE AND VASCULAR NEUROLOGY
Volume 2, Issue 2, Pages 73-83Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/svn-2016-000063
Keywords
rtPA; tissue plasminogen activator; cost-effectiveness; acute ischemic stroke
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Funding
- Intramural CDC HHS [CC999999] Funding Source: Medline
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Background Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for patients with acute ischaemic stroke, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischaemic stroke is not well reviewed. Aims To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times. Summary of review A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the keywords acute ischemic stroke, tissue plasminogen activator, cost, economic benefit, saving and incremental cost-effectiveness analysis. The review is limited to original research articles published during 1995-2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3hours after stroke onset, 2 studies within 3-4.5hours, 3 studies within 0-4.5hours and 2 studies within 0-6hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within 1 year was marginally above US$50000 per quality-adjusted life year threshold. IV rtPA within 0-3hours after stroke led to cost savings for lifetime or 30 years and IV rtPA within 3-4.5hours after stroke increased costs but still was cost-effective. Conclusions The literature generally showed that IV rtPA was a dominant or a cost-effective strategy compared with traditional treatment for patients with acute ischaemic stroke without IV rtPA. The findings from the literature lacked generalisability because of limited data and various assumptions.
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