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Area of Science:

  • Clinical Medicine
  • Health Economics
  • Pharmacoeconomics

Background:

  • Acute stroke management often involves balancing infection prevention with antimicrobial stewardship.
  • The cost-effectiveness of routine preventive antibiotics in acute stroke is not well-established.
  • Evaluating interventions from a societal perspective is crucial for healthcare policy.

Purpose of the Study:

  • To assess the cost-effectiveness of preventive ceftriaxone compared to standard stroke unit care.
  • To determine the cost-utility of adding preventive antimicrobial therapy in acute stroke patients.
  • To analyze resource utilization and economic impact from a societal viewpoint.

Main Methods:

  • A multicenter, randomized, open-label trial included 2,550 acute stroke patients.
  • Economic evaluation used a societal perspective over a 3-month horizon.
  • Cost-effectiveness and cost-utility analyses were based on modified Rankin Scale (mRS) and quality-adjusted life years (QALYs).

Main Results:

  • No significant difference in mRS scores between ceftriaxone and control groups.
  • A significant increase in QALYs was observed in the ceftriaxone group (0.008 difference, p=0.006).
  • Preventive ceftriaxone demonstrated a probability of 0.67-0.89 for cost-effectiveness.

Conclusions:

  • Preventive ceftriaxone shows a high probability (0.7) of being more cost-effective than standard care.
  • The addition of preventive ceftriaxone may be a cost-effective strategy for improving patient outcomes in acute stroke.
  • Further analysis supports ceftriaxone's value at specific willingness-to-pay thresholds for mRS and QALY improvements.