OBJECTIVES

The aim of this study was to assess cost-effectiveness of MRI-guided thrombolysis with intravenous alteplase for acute ischemic stroke in patients with unknown time of onset compared to placebo.

METHODS

A Markov model was designed to predict cost-effectiveness over a 25 year time horizon. The data used in this analysis was extracted from the WAKE-UP trial, a European multi-center randomized controlled trial investigating the effects of intravenous thrombolysis with alteplase vs placebo based on a mismatch in MRI imaging in patients with unknown time of symptom onset. Incremental costs and effects over the patients’ lifetime were estimated. The model consisted of an in-patient acute care phase and a rest of life phase. Health states were defined by the modified Rankin Scale score. After the initial stroke, patients remained in their mRS score until death or recurrent stroke. Health state utilities were extracted from published literature. Cost data of acute care was taken from the University Medical Center Hamburg-Eppendorf, Germany. To establish cost of long-term care in the rest-of-life phase, mRS scores were matched to German degrees of care based on expert opinion. The analysis was conducted from a German societal perspective.

RESULTS

Treatment with alteplase dominated placebo with incremental costs of 51,009€ ($40,807) and 1.30 gains in Quality-Adjusted Life Years (QALYs) at a discount rate of 5%. Univariate sensitivity analysis and probabilistic sensitivity analysis (Monet Carlo Simulation) was conducted to test robustness, both indicating robustness of our results across a wide range of parameters.

CONCLUSIONS

MRI-guided thrombolysis with intravenous alteplase compared to placebo is cost-effective in ischemic stroke patients with unknown time of onset.