A pharmacoeconomic assessment of recombinant tissue plasminogen activator therapy for acute ischemic stroke in a tertiary hospital in China

Objectives: To conduct a pharmacoeconomic assessment of thrombolysis by intravenous recombinant tissue plasminogen activator (rt-PA) therapy for acute ischemic stroke (AIS) in 6 hours in a tertiary hospital in China. Materials and methods: A retrospective analysis was conducted using medical records data among patients hospitalized for AIS and receiving treatment with or without rt-PA (6 hours after AIS) from January 2006 to December 2008. The conservative therapy group was matched (1 : 1) on age, gender, risk factors, Glasgow Coma Scale, and National Institutes of Health Stroke Scale (NIHSS). Two groups were compared on fourteenth-day clinical outcomes. Utilities were estimated from modified Rankin Scale (mRS) scores and costs. All cost data reflected 2006-2008 values. Results: A total of 152 patients were enrolled in the study (76 patients in each group). No differences were found in mortality rate between these two groups at day 14. Among survivors on day 14, NIHSS and mRS were lower in rt-PA than conservative group. Barth Index (BI) was higher in the rt-PA group versus conservative group. The rt-PA group had a higher pharmacy cost ((sic)13 065 +/- 4197 versus (sic)9622 +/- 5439; P = 0.002) compared to the conservative group, but the total cost was not significantly different. Compared to conservative care, rt-PA therapy was associated with incremental cost of (sic)4122 with 0.04 utilities gained, yielding an incremental cost-effectiveness ratio of (sic)103 050 ($14 231) per utility gained. One-way sensitivity analysis showed that the results were most sensitivity to utility. Conclusions: Intravenous rt-PA was associated with lower patients' disabilities, fewer in-hospital days, and comparable total costs compared to conservative therapy for the management of AIS.