Cost-effectiveness analysis of tissue plasminogen activator for acute ischemic stroke: A comparative review

Purpose: This work was undertaken to review current evidence of cost-effectiveness analysis (CEA) on thrombolysis for acute ischemic stroke. Methods: An electronic search via PubMed, from 1995 until May 2004, was performed. The methods undertaken by these studies were examined with particular attention to their modeling assumptions, sources of data, and outcome measures. Results: Three comprehensive CEAs of rtPA (recombinant tissue plasminogen activator) for acute ischemic stroke were reviewed. These studies were from the United States, Canada, and the United Kingdom. All these studies employed the perspective of a healthcare system and used a Markov decision-analytic modelling approach. Estimates of effectiveness of rtPA were based on the National Institute of Neurological Disorders and Stroke (NINDS) rtPA Stroke Trial, literature-derived values or a stroke registry. In each study, functional outcome measured by the modified Rankin Scale was used to represent health states, and quality-adjusted life year gained was the health outcome summary measure. The cost-effectiveness of rtPA therapy varied in magnitude, but seemingly with same positive implications. Conclusions: Cost-effectiveness analysis requires information on an intervention's effectiveness and country-specific sources of epidemiological and resource utilization data, most of which are not yet available in Taiwan. Despite the limitations, CEA is essential if a healthcare system would like to contain costs while maintaining, or improving, quality of care.