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. 2023 Sep;8(3):638-646.
doi: 10.1177/23969873231174943. Epub 2023 May 19.

Cost-effectiveness of tenecteplase versus alteplase for acute ischemic stroke

Chi Phuong Nguyen  1   2   3 , Maarten Mh Lahr  2 , Durk-Jouke van der Zee  1   2 , Henk van Voorst  4   5 , Yvo Bwem Roos  6 , Maarten Uyttenboogaart  7   8 , Erik Buskens  1   2
Affiliations

Cost-effectiveness of tenecteplase versus alteplase for acute ischemic stroke

Chi Phuong Nguyen et al. Eur Stroke J. 2023 Sep.

Abstract

Introduction: Alteplase is widely used as an intravenous thrombolytic drug in acute ischemic stroke (AIS). Recently however, tenecteplase, a modified form of tissue plasminogen activator, has been shown to increase early recanalization rate and has proven to be non-inferior with a similar safety profile compared to alteplase. This study aims to evaluate the cost-effectiveness of 0.25 mg/kg tenecteplase versus 0.9 mg/kg alteplase for intravenous thrombolysis in AIS patients from the Dutch healthcare payer perspective.

Methods: A Markov decision-analytic model was constructed to assess total costs, total quality-adjusted life year (QALY), an incremental cost-effectiveness ratio, and incremental net monetary benefit (INMB) of two treatments at willingness-to-pay (WTP) thresholds of €50,000/QALY and €80,000/QALY over a 10-year time horizon. One-way sensitivity analysis, probabilistic sensitivity analysis, and scenario analysis were conducted to test the robustness of results. Clinical data were obtained from large randomized controlled trials and real-world data.

Results: Treatment with tenecteplase saved €21 per patient while gaining 0.05 QALYs, resulting in INMB of €2381, clearly rendering tenecteplase cost-effective compared to alteplase. Importantly, tenecteplase remained the cost-effective alternative in all scenarios, including AIS patients due to large vessel occlusion (LVO). Probabilistic sensitivity analysis proved tenecteplase to be cost-effective with a 71.0% probability at a WTP threshold of €50,000/QALY.

Conclusions: Tenecteplase treatment was cost-effective for all AIS patients (including AIS patients with LVO) compared to alteplase. The finding supports the broader use of tenecteplase in acute stroke care, as health outcomes improve at acceptable costs while having practical advantages, and a similar safety profile.

Keywords: Stroke; alteplase; cost-effectiveness; tenecteplase.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Decision tree model and (b) Markov model. EVT: endovascular thrombectomy; M: Markov model; mRS: modified Rankin score.
Figure 2.
Figure 2.
One-way sensitivity results. EVT: endovascular thrombectomy; INMB: incremental net monetary benefit; mRS: modified Rankin Scale. Positive INMB indicates tenecteplase is cost-effective compared to alteplase at €50,000/QALY.
Figure 3.
Figure 3.
(a) Incremental cost-effectiveness plane for tenecteplase versus alteplase in base case at €50,000, (b) incremental cost-effectiveness plane for tenecteplase versus alteplase in base case at €80,000, and (c) cost-effectiveness acceptability curve for tenecteplase versus alteplase in base case. WTP: willingness-to-pay; QALY: quality-adjusted life year.
See this image and copyright information in PMC

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