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Cost-Utility Analysis of Tissue Plasminogen Activator Therapy for Acute Ischaemic Stroke

A Canadian Healthcare Perspective

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Abstract

Background: There are over 40 000 ischaemic strokes annually in Canada, which result in significant morbidity, mortality and burden to the healthcare system. A recent, large clinical trial has evaluated tissue plasminogen activator (t-PA) intravenously for the treatment of acute ischaemic stroke with promising outcomes but with an increased risk of symptomatic intracranial haemorrhage.

Objective: To compare clinical and economic outcomes of intravenous t-PA therapy (0.9 mg/kg, to a maximum of 90mg, initiated within 3 hours of stroke onset) versus no t-PA for acute ischaemic stroke based on the outcomes achieved in the National Institute of Neurological Disorders and Stroke (NINDS) trial.

Design: A Markov model depicting the natural lifetime course after an initial acute ischaemic stroke. On the basis of this model, a simulated trial compared no t-PA with t-PA.

Patients: A hypothetical cohort of 1000 patients with acute ischaemic stroke.

Study perspective: Canadian healthcare system.

Outcome measures: Total acute stroke and post-stroke treatment costs and cumulative quality-adjusted life-years (QALYs).

Results: For a hypothetical cohort of 1000 patients, the estimated lifetime stroke costs were 103 100 000 Canadian dollars ($Can) [1999 values) in the t-PA arm ($Can103 100 per patient) compared with $Can106 900 000 in the no t-PA arm ($Can106 900 per patient), yielding a lifetime cost difference of $Can3 800 000 in favour of t-PA versus no t-PA ($Can3800 per patient). In the hypothetical cohort, t-PA treatment resulted in 13 130 QALYs versus 9670 QALYs with no t-PA treatment. This translated into a net benefit of 3460 additional QALYs per 1000 patients (3.46 QALYs per patient). No treatment, outcome or economic variables influenced the model outcome.

Conclusion: From the standpoint of cost effectiveness, treatment of acute ischaemic stroke with intravenous t-PA is an economically attractive strategy.

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References

  1. Fisk B, Hebden T, MacGregor L, et al. Heart disease and stroke in British Columbia 1998. Vancouver (BC): Heart and Stroke Foundation of B.C. and Yukon, 1998

    Google Scholar 

  2. Gordon M. Monograph series on aging-related diseases: III. Stroke (cerebrovascular disease). Chronic Dis Can 1993; 14: 64–89

    Google Scholar 

  3. Wittkowsky AK. The stroke pharmacopeia: current medical therapies. Pharmacotherapy 1998; 18: 94S–100S

    PubMed  CAS  Google Scholar 

  4. Health Canada. Heart disease and stroke in Canada 1997. Health Canada [online]. Available from: URL: http://www.hcsc. gc.ca/hpb/lcdc/bcrdd/hdsc97/tab03_e.html [Accessed 1999 Sep 21]

  5. Alexandrov AV, Smurawska LT, Bartle W, et al. Cost considerations in the pharmacological prevention and treatment of stroke. Pharmacoeconomics 1997; 11: 408–15

    Article  PubMed  CAS  Google Scholar 

  6. Smurawska LT, Alexander AV, Bladin CF, et al. Cost of acute stroke care in Toronto, Canada. Stroke 1994; 25: 1628–31

    Article  PubMed  CAS  Google Scholar 

  7. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med 1995; 333: 1581–7

    Article  Google Scholar 

  8. Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017–25

    Article  PubMed  CAS  Google Scholar 

  9. Hacke W, Kaste M, Fieschi C, et al., Second European-Australasian Acute Stroke Study Investigators. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352: 1245–51

    Article  PubMed  CAS  Google Scholar 

  10. Adams HP, Brott TG, Furlan AJ, et al. Member’s guidelines for thrombolytic therapy for acute stroke: a supplement to the guidelines for the management of patients with acute ischemic stroke. A statement for healthcare professionals from a special writing group of the stroke council, American Heart Association. Circulation 1996; 94: 1167–74

    Article  PubMed  Google Scholar 

  11. Fagan SC, Morgenstern LB, Petitta A, et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. Neurology 1998; 59: 883–900

    Article  Google Scholar 

  12. Briggs A, Sculpher M. An introduction to Markov modeling for economic evaluation. Pharmacoeconomics 1998; 13: 397–409

    Article  PubMed  CAS  Google Scholar 

  13. van Sweiten JC, Koudstaal PJ, Visser MC, et al. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19: 604–7

    Article  Google Scholar 

  14. Solomon NA, Glick HA, Russo CH, et al. Patient preferences for stroke outcomes. Stroke 1994; 25: 1721–5

    Article  PubMed  CAS  Google Scholar 

  15. Canadian Coordinating Office of Health Technology Assessment. Guidelines for the economic evaluation of pharmaceuticals: Canada. 2nd ed. Ottawa (ON): Canadian Coordinating Office of Health Technology Assessment (CCOHTA), 1997

    Google Scholar 

  16. Statistics Canada. Population. Statistics Canada [online]. Available from: URL: http://www.statcan.ca/english/Pgdb/People/ Population/demo02.htm [Accessed 1999 Sep 22]

  17. Statistics Canada. National population health survey overview 1996–97. Ottawa (ON): Minister of Industry, 1998

    Google Scholar 

  18. British Columbia Medical Association. Guide to fees. Vancouver (BC): British Columbia Medical Association, 1998

    Google Scholar 

  19. Jacobs P, Hall EM, Bachnysky J. An Alberta standard cost list for health economics evaluations. Ottawa (ON): Canadian Coordinating Office of Health Technology Assessment (CCOHTA), 1997

    Google Scholar 

  20. Chan B, Hayes B. Cost of stroke in Ontario, 1994/95. CMAJ 1998; 159: S2–S8

    Google Scholar 

  21. Hodgson C. Prevalence and disabilities of community-living seniors who report the effects of stroke. CMAJ 1998; 159: S9–S14

    Google Scholar 

  22. Heart and Stroke Foundation of Ontario. Heart and Stroke Foundation of Ontario [online]. Available from: URL: http://www.hsf.on.ca/facts_stroke.htm [Accessed 1999 Sep 23]

    Google Scholar 

  23. Samsa G, Reutter R, Parmiigiani G, et al. Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: application to treatment of acute ischemic stroke. J Clin Epidemiol 1999; 52: 259–71

    Article  PubMed  CAS  Google Scholar 

  24. Oh P, Pritchard L. Thrombolytic therapy in stroke [abstract]. Can J Clin Pharmacol 1997; 4: 50

    Google Scholar 

  25. Nadareishvili Z, Oh P, Smurawska LT, et al. Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke [letter]. Neurology 1999; 52: 895

    PubMed  CAS  Google Scholar 

  26. Tran C, Nadareishvili Z, Oh P. Decreasing costs of stroke hospitalization in Toronto. Stroke 1999; 30: 185–6

    Article  PubMed  CAS  Google Scholar 

  27. Wardlaw JM, del Zoppo G, Yamaguchi T. Thrombolysis for acute ischaemic stroke [review]. Cochrane Database Syst Rev 2000; 2: CD000213

    PubMed  Google Scholar 

  28. Kwiatkowski TG, Libman RB, Frankel M, et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. N Engl J Med 1999; 340: 1781–7

    Article  PubMed  CAS  Google Scholar 

  29. Grond M, Stenzel C, Schmulling S, et al. Early intravenous thrombolysis for acute ischemic stroke in a community-based approach. Stroke 1998; 29: 1544–9

    Article  PubMed  CAS  Google Scholar 

  30. Wang DZ, Rose JA, Honings DS, et al. Treating acute stroke patients with intravenous tPA. Stroke 2000; 31: 77–8131

    Article  PubMed  CAS  Google Scholar 

  31. Albers GW, Bates VE, Clark WM, et al. Intravenous tissue-type plasminogen activator for treatment of acute stroke (STARS study). JAMA 2000; 283: 1145–50

    Article  PubMed  CAS  Google Scholar 

  32. Chiu D, Kreiger D, Villar-Cordova C, et al. Intravenous tissue plasminogen activator for acute ischemic stroke: feasibility, safety, and efficacy in the first year of clinical practice. Stroke 1998; 29: 18–22

    Article  PubMed  CAS  Google Scholar 

  33. Katzan IL, Furlan AJ, Lloyd LE, et al. Use of tissue-type plasminogen activator for acute ischemic stroke. JAMA 2000; 283: 1151–8

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

This study was funded by the B.C. and Yukon Heart and Stroke Foundation. Dr Teal has functioned as a consultant to Hoffman LaRoche and Dr Fagan is on the Speaker’s Bureau and has been a consultant for Genentech, Inc.

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Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada

    Shannon E. Sinclair

  2. Clinical Drug Research Program, Clinical Services Unit, Pharmaceutical Sciences, Vancouver Hospital and Health Sciences Center, and Faculty of Pharmaceutical Sciences, University of British Columbia, 855 West 12th Avenue, Vancouver, British Columbia, V5Z 1M9, Canada

    Luciana Frighetto, Peter S. Loewen, Rubina Sunderji &  Carlo A. Marra

  3. Neurology, Vancouver Hospital and Health Sciences Center, and Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada

    Philip Teal

  4. College of Pharmacy, University of Georgia, Athens, Georgia, USA

    Susan C. Fagan

  5. Formation Health Services Unit (Pacific), Canadian Forces Base Esquimalt, Victoria, British Columbia, Canada

    Shannon E. Sinclair

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  1. Shannon E. Sinclair
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  2. Luciana Frighetto
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  3. Peter S. Loewen
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  4. Rubina Sunderji
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  5. Philip Teal
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  6. Susan C. Fagan
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  7. Carlo A. Marra
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Corresponding author

Correspondence to Carlo A. Marra.

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Sinclair, S.E., Frighetto, L., Loewen, P.S. et al. Cost-Utility Analysis of Tissue Plasminogen Activator Therapy for Acute Ischaemic Stroke. Pharmacoeconomics 19, 927–936 (2001). https://doi.org/10.2165/00019053-200119090-00004

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  • DOI: https://doi.org/10.2165/00019053-200119090-00004

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