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Cost-Effectiveness of Tenecteplase Before Thrombectomy for Ischemic Stroke
Lan Gao1, Marj Moodie1, Peter J Mitchell2
1Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia (L.G., M.M.).
Stroke
|October 7, 2020
Summary
Tenecteplase is a cost-effective treatment for ischemic stroke patients with large vessel occlusion, offering better outcomes and long-term savings compared to alteplase. This approach reduces healthcare costs and improves quality-adjusted life-years.
Area of Science:
- Health Economics
- Neurology
- Pharmacoeconomics
Background:
- Tenecteplase demonstrated improved functional outcomes and reduced endovascular thrombectomy needs in ischemic stroke with large vessel occlusion.
- The EXTEND-IA TNK trial provided data for assessing tenecteplase's cost-effectiveness against alteplase.
Purpose of the Study:
- To evaluate the cost-effectiveness of tenecteplase compared to alteplase for acute ischemic stroke patients with large vessel occlusion.
- To analyze both within-trial and long-term economic impacts of tenecteplase treatment.
Main Methods:
- A within-trial economic analysis considered costs of stroke hospitalization, rehabilitation, and rehospitalization within 90 days.
- Quality-adjusted life-years (QALYs) were estimated using modified Rankin Scale scores; a Markov model was used for long-term analysis.
- Probabilistic and deterministic sensitivity analyses were performed to assess result robustness.
Main Results:
- Within 90 days, tenecteplase showed nonsignificantly lower costs (AUD 40,997 vs. 46,188) and higher QALYs (0.099) with 97.4% cost-effectiveness probability.
- Long-term analysis indicated tenecteplase had lower lifetime costs (AUD 96,357 vs. 106,304) and greater QALYs (7.77 vs. 6.48), with 100% cost-effectiveness probability.
- Tenecteplase was identified as the dominant treatment strategy in both short-term and long-term analyses.
Conclusions:
- Tenecteplase is highly likely to be cost-effective for acute ischemic stroke patients eligible for thrombectomy.
- Using tenecteplase over alteplase offers significant cost savings to the healthcare system in both the short and long term.
- The findings support the recommendation of tenecteplase as a preferred treatment option for this patient population.
