PharmacoEconomics & Outcomes News 632 - 9 Jul 2011

Interventional strategy worth it inischaemic stroke

Compared with IV alteplase alone, strategiesincluding adjunctive mechanical thrombectomy or intra-arterial thrombolysis "appear to have an acceptable cost-effectiveness profile" for treating large-vessel stroke,contend researchers from the US.

To evaluate the lifetime costs and outcomes of suchstrategies, the researchers constructed a decision-analysis model, using data derived from the Multi-MERCI study. Costs were calculated from a societalperspective, and all future costs and outcomes werediscounted at an annual rate of 3%.

The base-case scenario considered a 68-year-oldpatient with acute large-vessel ischaemic stroke whowas eligible for IV alteplase. Under this scenario, therecanalisation rate was modelled at 72.9% for theinterventional strategy involving adjunctive mechanicalthrombectomy or intra-arterial thrombolysis in additionto IV alteplase, and 46.2% for the medical strategy,involving IV alteplase alone. The symptomatichaemorrhage rate was calculated at 8.6% for theinterventional strategy with recanalisation, and at 15.4%without; the corresponding rates for the medicalstrategy were 3.6% and 13.3%, respectively.

The interventional strategy would cost an extra$US10 840 and provide a gain of 0.68 QALYs perpatient, compared with the medical strategy, resulting inan incremental cost-effectiveness ratio of $16 001 perQALY. Under sensitivity analysis, the interventionalstrategy was cost effective in 97.6% of simulations, saythe researchers.Kim AS, et al. A Cost-Utility Analysis of Mechanical Thrombectomy as anAdjunct to Intravenous Tissue-Type Plasminogen Activator for Acute Large-VesselIschemic Stroke. Stroke : 2 Jun 2011. Available from: URL: http://dx.doi.org/10.1161/strokeaha.110.606889 803056904

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PharmacoEconomics & Outcomes News 9 Jul 2011 No. 6321173-5503/10/0632-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved