Cost-effectiveness analysis of thrombolytic therapy for ischemic stroke in real-life clinical practice
Objective: to carry out a cost-effectiveness analysis of treating ischemic stroke (IS) patients with and without the use of TLT in real-life (routine) clinical practice. Material and Methods: 63 consecutive cerebral infarction patients hospitalized on an emergency basis at vascular centres of the City of Saratov were included from July 01st, 2013 to February 28th, 2014 into the undertaken open-label comparative prospective pharmacoeconomic study. Two groups of patients were formed to meet the objective of the comparative study. The first group consisted of patients who received standard therapy in combination with a thrombolytic; the second group included patients receiving only standard therapy. Neurological deficits were assessed by the National Institutes of Health Stroke Scale (NIHSS), the degree of functional limitations – by the modified Rankin scale (mRS) (on admission, were 4 overall points). The clinical and economic analysis of therapy was carried out with calculation of the cost-effectiveness ratio (CER). The following effectiveness criteria were used: ”neurological regression by NIHSS ≥4 during the first 24 hours of therapy“; “the degree of functional limitations by mRS 0-1 points after 3 months of therapy”. Results: the average cost of hospitalization of one patient in the group with TLT amounted 91,915 rubles, in the group without TLT – 59,008 rubles, however, when analyzing CER for all the effectiveness criteria used, the advantage of routine TLT was shown: for the criterion “neurological regression by NIHSS ≥4 during the first 24 hours of therapy” CER for TLT amounted 276,021 rubles, without TLT – 329,654 rubles; for the criterion “the degree of functional limitations by mRS 0-1 points after 3 months of therapy” for TLT amounted 200,688 rubles, without TLT – 287,844 rubles. Conclusions: TLT with Alteplase during the acute period of IS in the real-life clinical practice in Saratov Oblast is cost-effective.
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