Cost-Effectiveness of Low-Dose Compared to Standard-Dose Alteplase for Acute Ischemic Stroke in China : A Within-Trial Economic Evaluation of the ENCHANTED Study
© 2022 The Author(s). Published by S. Karger AG, Basel..
INTRODUCTION: The Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) showed that a low-dose alteplase was safe but not clearly non-inferior to standard-dose alteplase in acute ischemic stroke (AIS). Given the significant cost of this medicine, we undertook a cost-effectiveness analysis to determine the probability that low-dose is cost-effective relative to standard-dose alteplase in China.
METHODS: For ENCHANTED participants in China with available health cost data, cost-effectiveness and cost-utility analyses were undertaken in which death or disability (modified Rankin scale scores 2-6) at 90 days and quality-adjusted life-years (QALYs) were used as outcome measures, respectively. There was adherence to standard guidelines for health economic evaluations alongside non-inferiority trials and according to a health-care payer's perspective. The equivalence margin for cost and effectiveness was set at USD 691 and -0.025 QALYs, respectively, for the base-case analysis. Probabilistic sensitivity analyses were used to evaluate the probability of low-dose alteplase being non-inferior.
RESULTS: While the mean cost of alteplase was lower in the low-dose group (USD 1,569 vs. USD 2,154 in the standard-dose group), the total cost was USD 56 (95% confidence interval [CI]: -1,000-1,113) higher compared to the standard-dose group due to higher hospitalization costs in the low-dose group. There were 462 (95% CI: 415-509) and 410 (95% CI: 363-457) patients with death or disability per 1,000 patients in the low-dose and standard-dose groups, respectively. The low-dose group had marginally lower (0.008, 95% CI: -0.016-0.001) QALYs compared to their standard-dose counterparts. The low-dose group was found to have an 88% probability of being non-inferior based on cost-effectiveness versus the standard-dose group.
CONCLUSIONS: This health economic evaluation alongside the ENCHANTED indicates that the use of low-dose alteplase does not save overall healthcare costs nor lead to a gain in QALYs in the management of Chinese patients with AIS compared to the use of standard dose. There is little justification on economic grounds to shift from standard-of-care thrombolysis in AIS.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:52 |
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| Enthalten in: |
Cerebrovascular diseases (Basel, Switzerland) - 52(2023), 2 vom: 08., Seite 145-152 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Si, Lei [VerfasserIn] |
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| Links: |
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| Themen: |
Acute ischemic stroke |
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| Anmerkungen: |
Date Completed 26.04.2023 Date Revised 07.05.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1159/000525869 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Cost-Effectiveness of Low-Dose Compared to Standard-Dose Alteplase for Acute Ischemic Stroke in China |b A Within-Trial Economic Evaluation of the ENCHANTED Study |
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| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Author(s). Published by S. Karger AG, Basel. | ||
| 520 | |a INTRODUCTION: The Enhanced Control of Hypertension and Thrombolysis Stroke Study (ENCHANTED) showed that a low-dose alteplase was safe but not clearly non-inferior to standard-dose alteplase in acute ischemic stroke (AIS). Given the significant cost of this medicine, we undertook a cost-effectiveness analysis to determine the probability that low-dose is cost-effective relative to standard-dose alteplase in China | ||
| 520 | |a METHODS: For ENCHANTED participants in China with available health cost data, cost-effectiveness and cost-utility analyses were undertaken in which death or disability (modified Rankin scale scores 2-6) at 90 days and quality-adjusted life-years (QALYs) were used as outcome measures, respectively. There was adherence to standard guidelines for health economic evaluations alongside non-inferiority trials and according to a health-care payer's perspective. The equivalence margin for cost and effectiveness was set at USD 691 and -0.025 QALYs, respectively, for the base-case analysis. Probabilistic sensitivity analyses were used to evaluate the probability of low-dose alteplase being non-inferior | ||
| 520 | |a RESULTS: While the mean cost of alteplase was lower in the low-dose group (USD 1,569 vs. USD 2,154 in the standard-dose group), the total cost was USD 56 (95% confidence interval [CI]: -1,000-1,113) higher compared to the standard-dose group due to higher hospitalization costs in the low-dose group. There were 462 (95% CI: 415-509) and 410 (95% CI: 363-457) patients with death or disability per 1,000 patients in the low-dose and standard-dose groups, respectively. The low-dose group had marginally lower (0.008, 95% CI: -0.016-0.001) QALYs compared to their standard-dose counterparts. The low-dose group was found to have an 88% probability of being non-inferior based on cost-effectiveness versus the standard-dose group | ||
| 520 | |a CONCLUSIONS: This health economic evaluation alongside the ENCHANTED indicates that the use of low-dose alteplase does not save overall healthcare costs nor lead to a gain in QALYs in the management of Chinese patients with AIS compared to the use of standard dose. There is little justification on economic grounds to shift from standard-of-care thrombolysis in AIS | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute ischemic stroke | |
| 650 | 4 | |a Alteplase | |
| 650 | 4 | |a Clinical trial | |
| 650 | 4 | |a Cost-effectiveness | |
| 650 | 4 | |a Health economics | |
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| 650 | 7 | |a Fibrinolytic Agents |2 NLM | |
| 700 | 1 | |a Chen, Xiaoying |e verfasserin |4 aut | |
| 700 | 1 | |a Ouyang, Menglu |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Xia |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Guofang |e verfasserin |4 aut | |
| 700 | 1 | |a Cao, Yong-Jun |e verfasserin |4 aut | |
| 700 | 1 | |a Wu, Guojun |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jinli |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Jingfen |e verfasserin |4 aut | |
| 700 | 1 | |a Liu, YuKai |e verfasserin |4 aut | |
| 700 | 1 | |a Zhang, Shihong |e verfasserin |4 aut | |
| 700 | 1 | |a Song, Lili |e verfasserin |4 aut | |
| 700 | 1 | |a Delcourt, Candice |e verfasserin |4 aut | |
| 700 | 1 | |a Arima, Hisatomi |e verfasserin |4 aut | |
| 700 | 1 | |a Wang, Lidan |e verfasserin |4 aut | |
| 700 | 1 | |a Lung, Thomas |e verfasserin |4 aut | |
| 700 | 1 | |a Chen, Mingsheng |e verfasserin |4 aut | |
| 700 | 1 | |a Anderson, Craig S |e verfasserin |4 aut | |
| 700 | 1 | |a Jan, Stephen |e verfasserin |4 aut | |
| 700 | 0 | |a ENCHANTED Investigators |e verfasserin |4 aut | |
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