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Cost-Effectiveness of Thrombolysis within 4.5 Hours of Acute Ischemic Stroke in China

Author

Listed:
  • Yuesong Pan
  • Qidong Chen
  • Xingquan Zhao
  • Xiaoling Liao
  • Chunjuan Wang
  • Wanliang Du
  • Gaifen Liu
  • Liping Liu
  • Chunxue Wang
  • Yilong Wang
  • Yongjun Wang
  • for the TIMS-CHINA investigators

Abstract

Background: Previous economic studies conducted in developed countries showed intravenous tissue-type plasminogen activator (tPA) is cost-effective for acute ischemic stroke. The present study aimed to determine the cost-effectiveness of tPA treatment in China, the largest developing country. Methods: A combination of decision tree and Markov model was developed to determine the cost-effectiveness of tPA treatment versus non-tPA treatment within 4.5 hours after stroke onset. Outcomes and costs data were derived from the database of Thrombolysis Implementation and Monitor of acute ischemic Stroke in China (TIMS-China) study. Efficacy data were derived from a pooled analysis of ECASS, ATLANTIS, NINDS, and EPITHET trials. Costs and quality-adjusted life-years (QALYs) were compared in both short term (2 years) and long term (30 years). One-way and probabilistic sensitivity analyses were performed to test the robustness of the results. Results: Comparing to non-tPA treatment, tPA treatment within 4.5 hours led to a short-term gain of 0.101 QALYs at an additional cost of CNY 9,520 (US$ 1,460), yielding an incremental cost-effectiveness ratio (ICER) of CNY 94,300 (US$ 14,500) per QALY gained in 2 years; and to a long-term gain of 0.422 QALYs at an additional cost of CNY 6,530 (US$ 1,000), yielding an ICER of CNY 15,500 (US$ 2,380) per QALY gained in 30 years. Probabilistic sensitivity analysis showed that tPA treatment is cost-effective in 98.7% of the simulations at a willingness-to-pay threshold of CNY 105,000 (US$ 16,200) per QALY. Conclusions: Intravenous tPA treatment within 4.5 hours is highly cost-effective for acute ischemic strokes in China.

Suggested Citation

  • Yuesong Pan & Qidong Chen & Xingquan Zhao & Xiaoling Liao & Chunjuan Wang & Wanliang Du & Gaifen Liu & Liping Liu & Chunxue Wang & Yilong Wang & Yongjun Wang & for the TIMS-CHINA investigators, 2014. "Cost-Effectiveness of Thrombolysis within 4.5 Hours of Acute Ischemic Stroke in China," PLOS ONE, Public Library of Science, vol. 9(10), pages 1-8, October.
    • Handle: RePEc:plo:pone00:0110525
    DOI: 10.1371/journal.pone.0110525
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    References listed on IDEAS

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    1. Joyce H S You & Kia K N Tsui & Raymond S M Wong & Gergory Cheng, 2012. "Cost-Effectiveness of Dabigatran versus Genotype-Guided Management of Warfarin Therapy for Stroke Prevention in Patients with Atrial Fibrillation," PLOS ONE, Public Library of Science, vol. 7(6), pages 1-9, June.
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