OBJECTIVES: Alteplase is widely used as intravenous thrombolytic medication in acute ischemic stroke (AIS). However, tenecteplase, a genetically modified form of alteplase, has recently been shown to result in higher recanalization rates, improved functional outcome and a similar safety profile in AIS patients with large vessel occlusion (LVO) compared to alteplase. Accordingly, this study aims to evaluate the cost-effectiveness of 0.25mg/kg tenecteplase versus 0.9mg/kg alteplase for thrombolysis in AIS patients due to LVO from the Dutch healthcare payer perspective.

METHODS: A Markov decision-analytic model was constructed to assess total costs, total quality-adjusted life year (QALY), and an incremental cost-effectiveness ratio (ICER) of two treatments at a willingness-to-pay threshold of €50,000/QALY over a 10-year time horizon. One-way sensitivity analysis, probabilistic sensitivity analysis and scenario analysis were conducted to test the robustness of our modeled results. Clinical data were obtained from large randomized controlled trials and real-world data.

RESULTS: Over a 10-year time horizon, treatment with tenecteplase appeared to cost €4,717 extra while gaining 0.62 QALYs, resulting in an ICER of €7,560/QALY, rendering tenecteplase cost-effective compared to alteplase. Importantly, tenecteplase remained the cost-effective treatment in all scenarios, and probabilistic sensitivity analysis proved tenecteplase to be cost-effective with 95.6% probability.

CONCLUSIONS: Tenecteplase treatment was highly cost-effective for AIS patients due to LVO compared to alteplase treatment. The finding supports tenecteplase’s broader use in acute stroke care as health outcomes improve at acceptable costs, while having practical advantages, and a similar safety profile.