Acute ‘strokenomics’: efficacy and economic analyses of alteplase for acute ischemic stroke

Abstract

Cerebrovascular disease is the leading cause of adult disability in Western countries and, as such, is associated with a considerable and increasing economic burden. Prevention of disability is preferable to a costly and prolonged period of rehabilitation; however, in this regard, we have only a limited number of acute treatments. Treatment of ischemic stroke with the tissue plasminogen activator alteplase has a considerable and compelling evidence base confirming its clinical efficacy. Good-quality trial data are complemented by years of ‘real-life’ clinical experience. There is limited pharmacoeconomic literature describing the use of alteplase in ischemic stroke, and published data are consistent and broadly supportive of its use in select patient populations. Delivery of stroke and other medical care can differ across countries; however, models based on American, Canadian and European data suggest that following initial monetary investment, net healthcare-associated costs for tissue plasminogen activator-treated patients are less than for untreated contemporaries. Potential savings are driven by reduced disability and associated long-term care costs. At present, robust economic data are only available for the period of 1-year following stroke. Continuing cost savings associated with reduced disability in the longer term make intuitive sense but are yet to be confirmed. A recurring theme in these economic analyses is of reducing healthcare costs associated with the increasing use of thrombolysis. In this regard, it is unfortunate that rates of tissue plasminogen activator utilization remain modest in most centers. This review will discuss the economics of alteplase in acute stroke, making particular reference to the current and projected economic burden of stroke, the evidence base for thrombolysis and published literature on the economics analyses of this therapy.

Keywords::

• alteplase
• cerebrovascular accident
• clinical trial
• cost–effectiveness
• economics
• tissue plasminogen activator
• thrombolytic therapy

Acknowledgements

We gratefully acknowledge the assistance of the three peer-reviewers in the writing of the manuscript.

Financial & competing interests disclosure

Both authors have written review and editorial material in favor of increasing the use of thrombolysis. Both authors have recruited patients for recent multicenter thrombolysis trials. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.