Using real world evidence to generate cost-effectiveness analysis of fibrinolytic therapy in patients with ST-segment elevation myocardial infarction in Thailand
© 2022 The Authors..
Background: Due to limited access to primary percutaneous coronary intervention for the management of ST-segment elevation myocardial infarction (STEMI) in low-to-middle-income countries (LMICs), fibrinolysis serves as a vital alternative reperfusion therapy. Among fibrinolytic agents, the cost-effectiveness of tenecteplase (TNK) in LMICs as compared to streptokinase (SK) for STEMI management remains unknown.
Methods: Cost-effectiveness was analyzed using a hybrid model consisting of short-term analysis (30-days decision tree model) and long-term analysis (Markov model). Both health care provider and societal perspectives over a lifetime horizon with 3% discount rate were considered. Input parameters were obtained from Thailand's national health database, a network meta-analysis and literature review. Outcome measure was an incremental cost-effectiveness ratio (ICER) determined by an incremental cost per quality-adjusted life years (QALY) gain. An ICER of less than $5,590 per QALY gain is considered cost-effective. Series of sensitivity analyses were also performed.
Findings: From the societal perspective, TNK increases cost by $827 and increases QALY by 0·173. Thus, the ICER is $4,777 per QALY gained. Similarly, the ICER from health care provider perspective is $4,664 per QALY gained. In the probabilistic sensitivity analysis, using 5,590 USD per QALY as threshold, the probability of TNK being cost-effective was 83% from both perspectives. The most influential parameters were risk ratio of death for treatment with TNK compared to SK and drug cost of TNK.
Interpretation: In a resource-limited country like Thailand, tenecteplase is a cost-effective fibrinolytic drug for treatment of STEMI compared to streptokinase.
Funding: None.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:26 |
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| Enthalten in: |
The Lancet regional health. Western Pacific - 26(2022) vom: 27. Sept., Seite 100503 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Trerayapiwat, Krittimeth [VerfasserIn] |
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| Links: |
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| Themen: |
Cost-effectiveness |
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| Anmerkungen: |
Date Revised 16.07.2022 published: Electronic-eCollection Citation Status PubMed-not-MEDLINE |
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| doi: |
10.1016/j.lanwpc.2022.100503 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM343104784 |
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| 520 | |a © 2022 The Authors. | ||
| 520 | |a Background: Due to limited access to primary percutaneous coronary intervention for the management of ST-segment elevation myocardial infarction (STEMI) in low-to-middle-income countries (LMICs), fibrinolysis serves as a vital alternative reperfusion therapy. Among fibrinolytic agents, the cost-effectiveness of tenecteplase (TNK) in LMICs as compared to streptokinase (SK) for STEMI management remains unknown | ||
| 520 | |a Methods: Cost-effectiveness was analyzed using a hybrid model consisting of short-term analysis (30-days decision tree model) and long-term analysis (Markov model). Both health care provider and societal perspectives over a lifetime horizon with 3% discount rate were considered. Input parameters were obtained from Thailand's national health database, a network meta-analysis and literature review. Outcome measure was an incremental cost-effectiveness ratio (ICER) determined by an incremental cost per quality-adjusted life years (QALY) gain. An ICER of less than $5,590 per QALY gain is considered cost-effective. Series of sensitivity analyses were also performed | ||
| 520 | |a Findings: From the societal perspective, TNK increases cost by $827 and increases QALY by 0·173. Thus, the ICER is $4,777 per QALY gained. Similarly, the ICER from health care provider perspective is $4,664 per QALY gained. In the probabilistic sensitivity analysis, using 5,590 USD per QALY as threshold, the probability of TNK being cost-effective was 83% from both perspectives. The most influential parameters were risk ratio of death for treatment with TNK compared to SK and drug cost of TNK | ||
| 520 | |a Interpretation: In a resource-limited country like Thailand, tenecteplase is a cost-effective fibrinolytic drug for treatment of STEMI compared to streptokinase | ||
| 520 | |a Funding: None | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Cost-effectiveness | |
| 650 | 4 | |a Fibrinolytic therapy | |
| 650 | 4 | |a Real-world evidence | |
| 650 | 4 | |a STEMI | |
| 650 | 4 | |a Streptokinase | |
| 650 | 4 | |a Tenecteplase | |
| 700 | 1 | |a Jinatongthai, Peerawat |e verfasserin |4 aut | |
| 700 | 1 | |a Vathesatogkit, Prin |e verfasserin |4 aut | |
| 700 | 1 | |a Sritara, Piyamitr |e verfasserin |4 aut | |
| 700 | 1 | |a Paengsai, Ninutcha |e verfasserin |4 aut | |
| 700 | 1 | |a Dilokthornsakul, Piyameth |e verfasserin |4 aut | |
| 700 | 1 | |a Nathisuwan, Surakit |e verfasserin |4 aut | |
| 700 | 1 | |a Le, Lan My |e verfasserin |4 aut | |
| 700 | 1 | |a Chaiyakunapruk, Nathorn |e verfasserin |4 aut | |
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