The cost-effectiveness of a thrombolytic agent used to treat stroke is all but a slam dunk from a payer’s perspective, according to a study published online Sept. 4 in Stroke. The authors recommended using their updated cost analysis to inform future reimbursement policies.
The last cost-effectiveness study on the use of recombinant tissue-type plasminogen activator (r-tPA) up to three hours of the onset of stroke symptoms occurred more than 15 years ago. Denise M. Boudreau, PhD, of the University of Washington in Seattle, and colleagues wanted to revisit the topic using contemporary data. The 1998 study supported the use of r-tPA from a cost perspective, with savings of about $4,000 per person treated.
Boudreau et al developed a decision analytic model that incorporated data from recent trials, meta-analyses, current medical costs, stroke recurrence rates and mortality rates. The analysis was from a payer perspective in the U.S. with costs inflated to 2013 dollars. The study assumed direct costs only.
Their base case analysis showed lifetime medical costs of r-tPA administered between zero to three hours of symptom onset of acute ischemic stroke at $287,400 compared with $312,400 if r-tPA was not used. On average, each patient treated with r-tPA gained 0.39 quality-adjusted life years (QALYs) with a lifetime cost savings of approximately $25,000 compared with untreated patients.
In probabilistic sensitivity analyses, r-tPA treatment trumped no treatment virtually every time in simulations.
“From a policy perspective, 39 years of QALYs would be gained, and over 2.5 million US dollars saved in medical costs for every 100 patients treated with r-tPA within 0 to 3 hours of AIS [acute ischemic stroke] symptom onset,” Boudreau et al wrote. They calculated that the annual cost of stroke disability increased 60 percent from the 1998 analysis.
They also observed that r-tPA is underused, despite guideline recommendations. They proposed that hospitals lack the infrastructure and organization to triage and treat patient within the target window.
While many effective approaches exist to facilitate rapid treatment, they require resources such as staff and equipment. Their findings might serve as evidence to alleviate that problem, they wrote, by persuading policy makers to recalibrate diagnostic related group codes for stroke.