Cost-Effectiveness of Tenecteplase Before Thrombectomy for Ischemic Stroke

WHAT ABSOLUTE FUCKING STUPIDITY,  

'COST EFFECTIVENESS' NOT RESULTS 

You all need to be fired! Get to 100% recovery and then you can work on costs.

Cost-Effectiveness of Tenecteplase Before Thrombectomy for Ischemic Stroke

 

Lan Gao

,

Marj Moodie

,

Peter J. Mitchell

,

Leonid Churilov

,

Timothy J. Kleinig

,

Nawaf Yassi

,

Bernard Yan

,

Mark W. Parsons

,

Geoffrey A. Donnan

,

Stephen M. Davis

, … See all authors

Originally published7 Oct 2020https://doi.org/10.1161/STROKEAHA.120.029666Stroke. ;0

Abstract

Background and Purpose:

Tenecteplase improved functional outcomes and reduced the requirement for endovascular thrombectomy in ischemic stroke patients with large vessel occlusion in the EXTEND-IA TNK randomized trial. We assessed the cost-effectiveness of tenecteplase versus alteplase in this trial.

Methods:

Post hoc within-trial economic analysis included costs of index emergency department and inpatient stroke hospitalization, rehabilitation/subacute care, and rehospitalization due to stroke within 90 days. Sources for cost included key study site complemented by published literature and government websites. Quality-adjusted life-years were estimated using utility scores derived from the modified Rankin Scale score at 90 days. Long-term modeled cost-effectiveness analysis used a Markov model with 7 health states corresponding to 7 modified Rankin Scale scores. Probabilistic sensitivity analyses were performed.

Results:

Within the 202 patients in the randomized controlled trial, total cost was nonsignificantly lower in the tenecteplase-treated patients (40 997 Australian dollars [AUD]) compared with alteplase-treated patients (46 188 AUD) for the first 90 days(P=0.125). Tenecteplase was the dominant treatment strategy in the short term, with similar cost (5412 AUD [95% CI, −13 348 to 2523]; P=0.181) and higher benefits (0.099 quality-adjusted life-years [95% CI, 0.001–0.1967]; P=0.048), with a 97.4% probability of being cost-effective. In the long-term, tenecteplase was associated with less additional lifetime cost (96 357 versus 106 304 AUD) and greater benefits (quality-adjusted life-years, 7.77 versus 6.48), and had a 100% probability of being cost-effective. Both deterministic sensitivity analysis and probabilistic sensitivity analyses yielded similar results.

Conclusions:

Both within-trial and long-term economic analyses showed that tenecteplase was highly likely to be cost-effective for patients with acute stroke before thrombectomy. Recommending the use of tenecteplase over alteplase could lead to a cost saving to the healthcare system both in the short and long term.

Registration:

URL: https://www.clinicaltrials.gov. Unique identifier: NCT02388061.