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    Cost-effectiveness of targeted thrombolytic therapy for stroke patients using multi-modal CT compared to usual practice

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    Author
    Reeves, P; Edmunds, K; Levi, C; Lin, L; Cheng, X; Aviv, R; Kleinig, T; Butcher, K; Zhang, J; Parsons, M; ...
    Date
    2018-10-23
    Source Title
    PLoS One
    Publisher
    PUBLIC LIBRARY SCIENCE
    University of Melbourne Author/s
    Bivard, Andrew; Parsons, Mark
    Affiliation
    Medicine and Radiology
    Metadata
    Show full item record
    Document Type
    Journal Article
    Citations
    Reeves, P., Edmunds, K., Levi, C., Lin, L., Cheng, X., Aviv, R., Kleinig, T., Butcher, K., Zhang, J., Parsons, M. & Bivard, A. (2018). Cost-effectiveness of targeted thrombolytic therapy for stroke patients using multi-modal CT compared to usual practice. PLOS ONE, 13 (10), https://doi.org/10.1371/journal.pone.0206203.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253082
    DOI
    10.1371/journal.pone.0206203
    Abstract
    INTRODUCTION: The use of multimodal computed tomography imaging (MMCT) in routine clinical assessment of stroke patients improves the identification of patients with large regions of salvageable brain tissue, lower risk for haemorrhagic transformation, or a large vessel occlusion requiring endovascular therapy. AIM: To evaluate the cost-effectiveness of using MMCT compared to usual practice for determining eligibility for reperfusion therapy with alteplase using real world data from the International Stroke Perfusion Imaging Registry (INSPIRE). METHODS: We performed a cost-utility analysis. Mean costs and quality-adjusted life years (QALYs) per patient for two alternative screening protocols were calculated. Protocol 1 represented usual practice, while Protocol 2 reflected treatment targeting using multimodal imaging. Cost-effectiveness was assessed using the net-benefit framework. RESULTS: Protocol 1 had a total mean per patient cost of $2,013 USD and 0.148 QALYs. Protocol 2 had a total mean per patient cost of $1,519 USD and 0.153 QALYs. For a range of willingness-to-pay values, representing implicit thresholds of cost-effectiveness, the lower bound of the incremental net monetary benefit statistic was consistently greater than zero, indicating that MMCT is cost- effective compared to usual practice. The results were most sensitive to variation in the mean number of alteplase vials administered. CONCLUSION: In a healthcare setting where multimodal imaging technologies are available and reimbursed, their use in screening patients presenting with acute stroke to determine eligibility for alteplase treatment is cost-effective given a range of willingness-to-pay thresholds and warrants consideration as an alternative to routine practice.

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