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Cost-Effectiveness of Low-Dose Compared to Standard-Dose Alteplase for Acute Ischemic Stroke in China: A Within-Trial Economic Evaluation of the ENCHANTED Study.
Si, Lei; Chen, Xiaoying; Ouyang, Menglu; Wang, Xia; Chen, Guofang; Cao, Yong-Jun; Wu, Guojun; Zhang, Jinli; Zhang, Jingfen; Liu, YuKai; Zhang, Shihong; Song, Lili; Delcourt, Candice; Arima, Hisatomi; Wang, Lidan; Lung, Thomas; Chen, Mingsheng; Anderson, Craig S; Jan, Stephen.
Afiliação
  • Si L; The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Chen X; School of Health Policy & Management, Nanjing Medical University, Nanjing, China.
  • Ouyang M; The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia, xchen@georgeinstitute.org.au.
  • Wang X; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia, xchen@georgeinstitute.org.au.
  • Chen G; The George Institute China at Peking University Health Science Centre, Beijing, China, xchen@georgeinstitute.org.au.
  • Cao YJ; The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Wu G; The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Zhang J; Xuzhou Central Hospital, Xuzhou, China.
  • Zhang J; The Second Affiliated Hospital of Soochow University, Soochow, China.
  • Liu Y; Hebei Yutian County Hospital, Tangshan, China.
  • Zhang S; The People's Liberation Army No. 263 Hospital, Beijing, China.
  • Song L; Inner Mongolia Baotou City Central Hospital, Baotou, China.
  • Delcourt C; The First Hospital of Nanjing, Nanjing, China.
  • Arima H; West China Hospital Sichuan University, Chengdu, China.
  • Wang L; The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Lung T; The George Institute China at Peking University Health Science Centre, Beijing, China.
  • Chen M; The People's Liberation Army No. 85 Hospital, Shanghai, China.
  • Anderson CS; The George Institute for Global Health, University of New South Wales, Kensington, New South Wales, Australia.
  • Jan S; Department of Clinical Medicine, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
Cerebrovasc Dis ; 52(2): 145-152, 2023.
Article em En | MEDLINE | ID: mdl-36044836
ABSTRACT

INTRODUCTION:

The Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) showed that a low-dose alteplase was safe but not clearly non-inferior to standard-dose alteplase in acute ischemic stroke (AIS). Given the significant cost of this medicine, we undertook a cost-effectiveness analysis to determine the probability that low-dose is cost-effective relative to standard-dose alteplase in China.

METHODS:

For ENCHANTED participants in China with available health cost data, cost-effectiveness and cost-utility analyses were undertaken in which death or disability (modified Rankin scale scores 2-6) at 90 days and quality-adjusted life-years (QALYs) were used as outcome measures, respectively. There was adherence to standard guidelines for health economic evaluations alongside non-inferiority trials and according to a health-care payer's perspective. The equivalence margin for cost and effectiveness was set at USD 691 and -0.025 QALYs, respectively, for the base-case analysis. Probabilistic sensitivity analyses were used to evaluate the probability of low-dose alteplase being non-inferior.

RESULTS:

While the mean cost of alteplase was lower in the low-dose group (USD 1,569 vs. USD 2,154 in the standard-dose group), the total cost was USD 56 (95% confidence interval [CI] -1,000-1,113) higher compared to the standard-dose group due to higher hospitalization costs in the low-dose group. There were 462 (95% CI 415-509) and 410 (95% CI 363-457) patients with death or disability per 1,000 patients in the low-dose and standard-dose groups, respectively. The low-dose group had marginally lower (0.008, 95% CI -0.016-0.001) QALYs compared to their standard-dose counterparts. The low-dose group was found to have an 88% probability of being non-inferior based on cost-effectiveness versus the standard-dose group.

CONCLUSIONS:

This health economic evaluation alongside the ENCHANTED indicates that the use of low-dose alteplase does not save overall healthcare costs nor lead to a gain in QALYs in the management of Chinese patients with AIS compared to the use of standard dose. There is little justification on economic grounds to shift from standard-of-care thrombolysis in AIS.
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Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / AVC Isquêmico Limite: Humans País/Região como assunto: Asia Idioma: En Ano de publicação: 2023
Texto completo
Imprimir
XML
PubMed Links
Buscar no Google

Texto completo: 1 Base de dados: MEDLINE Assunto principal: Isquemia Encefálica / Acidente Vascular Cerebral / AVC Isquêmico Limite: Humans País/Região como assunto: Asia Idioma: En Ano de publicação: 2023