OBJECTIVES : Cerebrovascular Stroke (CVS) is a major factor causing death and disability in adults in the USA. The most common type of CVS is Acute Ischemic Stroke (AIS). The FDA approved therapy for reducing disability due to AIS is the Intravenous recombinant tissue-type plasminogen activator (r-tPA) known as Alteplase. A new genetically modified less expensive variant of Alteplase is Tenecteplase which was proved effective in a clinical trial conducted in Australia by Campbell et al. The aim of this study is to analyze which is the more cost-effective treatment (Tenecteplase or Alteplase or no treatment) from a payer’s perspective for treating AIS.

METHODS : The study was conducted using Decision science analysis methods to develop a deterministic, aggregate level static Markov model with a hypothetical cohort of patients with AIS using the Treeage software. The model was utilized to estimate the Quality-adjusted Life expectancy (QALE) with each intervention and cost-effectiveness analysis was conducted from a payer’s perspective using a lifetime horizon. The probabilities and costs were derived from relevant published literature and discounted at 3% per year. The outcome was modified Rankin score (mRS) at 3 months (1-6) and was grouped into 3 categories, 0-1 (non-disabled), 2-5 (disabled) and 6 (death). Sensitivity Analysis was conducted using a one-way deterministic sensitivity analysis and a probabilistic sensitivity analysis.

RESULTS : The cost-effectiveness analysis showed that Tenecteplase was more effective and less expensive (QALE: 3.27 years, cost:138,807.80$) compared to Alteplase (QALE:2.77 years, cost:140656.71$) and the no treatment option (QALE: 1.82 years, cost: 99714.23$). The Incremental Cost-Effectiveness ratio (ICER) calculated was 27039$ which is below the WTP threshold of 100,000$. Sensitivity analysis also showed that Tenecteplase was cost effective compared to Alteplase.

CONCLUSIONS : Based on these results, Tenecteplase is proven to be cost-effective at a WTP threshold of 100,000$ when compared to no treatment or Alteplase for treatment of AIS.