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2017 ; 2
(2
): 73-83
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A literature review of cost-effectiveness of intravenous recombinant tissue
plasminogen activator for treating acute ischemic stroke
#MMPMID28736623
Joo H
; Wang G
; George MG
Stroke Vasc Neurol
2017[]; 2
(2
): 73-83
PMID28736623
show ga
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.