Cost-Effectiveness of rhTNK-tPA Versus rt-PA for Acute Ischemic Stroke Patients With 4.5H of Symptom Onset in China

OBJECTIVES: To evaluate the cost-effectiveness of rhTNK-tPA comparing to rt-PA for acute ischemic stroke patients whith 4.5h of symptom onset in Chinese healthcare setting.

METHODS: The analysis was based on a Markov model that estimated quality-adjusted life years (QALYs), direct medical costs, and incremental cost-effectiveness ratios (ICERs). The efficacy and safety data, drug costs, other direct medical expenses, and utility value data were sourced from TRACE Phase III clinical trial and literature databases. The cycle length is 3 months, and the model simulates the results in a short term of 1 year and a long term of 20 years. One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) were used to test the robustness of the model.

RESULTS: The results of cost-effectiveness analysis of revealed the overall costs are ¥29,571 in rhTNK-tPA, ¥33,885 in rt-PA respectively in 1 year, and ¥143,547 in rhTNK-tPA while ¥156,700 in rt-PA for 20 years. The QALYs gained are 0.67 and 0.66 in 1 yea, and 5.40 and 5.26 in 20 years, respectively. The rhTNK-tPA group generates lower treatment costs and better quality of life improvement, and thus could be considered a dominant alternative. The results of the one-way sensitivity analysis indicated that the utility of mRS 1-2 patients in rt-PA, the proportion of mRS 1-2 patients in rt-PA after treatment within 90 days, the utility of mRS 1-2 patients in rhTNK-tPA were the three most influential factors. The PSA result showed that at a willingness-to-pay threshold of 1.5 times the GDP per capita, the probability that rhTNK-tPA was cost-effective compared to the rt-PA regimen was 84.88%.

CONCLUSIONS: From the perspective of Chinese national healthcare system, we conclude that compared to the rt-PA regimen, rhTNK-tPA is a cost-effective option for acute ischemic stroke patients.