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Review
. 2017;2(2):73-83.
doi: 10.1136/svn-2016-000063. Epub 2017 Apr 28.

A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischemic stroke

Heesoo Joo  1 , Guijing Wang  2 , Mary G George  2
Affiliations
Review

A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischemic stroke

Heesoo Joo et al. Stroke Vasc Neurol. 2017.

Abstract

Background: Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic 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 key words 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 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 2 study within 0-6 hours. 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 one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective.

Conclusions: The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.

Keywords: acute ischemic stroke; cost-effectiveness; rtPA; tissue plasminogen activator.

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Conflict of interest statement

Conflict of interest: None

Figures

Figure 1
Figure 1
Selection of studies on cost-effectiveness analysis of recombinant tissue plasminogen activator (rtPA) for acute ischaemic stroke.
Figure 2
Figure 2
Conceptual framework of cost-effectiveness of recombinant tissue plasminogen activator (rtPA) therapy. ICER, incremental cost-effectiveness analysis; QALY, quality-adjusted life year.
Figure 3
Figure 3
Summary of incremental cost-effectiveness ratio (ICERs) of rtPA therapy from the literature. IV rtPA, intravenous recombinant tissue plasminogen activator; QALY, quality-adjusted life year.
See this image and copyright information in PMC

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References

    1. Krishnamurthi RV, Feigin VL, Forouzanfar MH, et al. . Global Burden of Diseases, Injuries, Risk Factors Study 2010 (GBD 2010) GBD Stroke Experts Group. Global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet Glob Health 2013;1:e259–e281. doi:10.1016/S2214-109X(13)70089-5 - DOI - PMC - PubMed
    1. World Health Organization. The world health report 2002. Midwifery 2003;19:72–3. - PubMed
    1. Heidenreich PA, Trogdon JG, Khavjou OA, et al. . American Heart Association Advocacy Coordinating Committee, Stroke Council, Council on Cardiovascular Radiology and Intervention, Council on Clinical Cardiology, Council on Epidemiology and Prevention, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation, Council on Cardiovascular Nursing, Council on the Kidney in Cardiovascular Disease, Council on Cardiovascular Surgery and Anesthesia, and Interdisciplinary Council on Quality of Care and Outcomes Research. Forecasting the future of cardiovascular disease in the united states: a policy statement from the american heart association. Circulation 2011;123:933–44. doi:10.1161/CIR.0b013e31820a55f5 - DOI - PubMed
    1. Gustavsson A, Svensson M, Jacobi F, et al. . CDBE2010Study Group. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011;21:718–79. doi:10.1016/j.euroneuro.2011.08.008 - DOI - PubMed
    1. Truelsen T, Begg S, Mathers C. The global burden of cerebrovascular disease. 2000. http://www.who.int/healthinfo/statistics/bod_cerebrovasculardiseasestrok....

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