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| Thrombolysis with alteplase is cost-effective and offers large long-term savings |
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January 2008
A recent study entitled "National use of thrombolysis with alteplase for acute ischaemic stroke via telemedicine in Denmark : a model of budgetary impact and cost effectiveness" assessed the national use of thrombolysis with alteplase (recombinant tissue plasminogen activator; rt-PA) for acute ischaemic stroke via telemedicine in Denmark.
L. Ehlers and his colleagues from the HTA Unit, Aarhus University Hospital, Aarhus, Denmark run computations based on a Danish health economic model of thrombolysis treatment of acute ischaemic stroke via telemedicine. The investigators took cost data for stroke units and satellite clinics from the first practical experience in Denmark with implementing thrombolysis via telemedical linkage to the Stroke Department at Aarhus University Hospital. Effectiveness data were taken from a published pooled analysis of results from randomised controlled trials of alteplase.
The calculations presented by the authors showed that the additional total costs to the hospitals of implementing thrombolysis with alteplase for acute ischaemic stroke via telemedicine were approximately US$ 3.0 (range 2.0–5.8) million per year in the case of five centres and five satellite clinics, or US$ 3.6 (range 2.4–7.0) million per year based on seven centres and seven satellite clinics.
The incremental cost-effectiveness ratio was calculated to be approximately US$ 50,000 in the short perspective (1 year), but thrombolysis was dominant (both cheaper and more effective) after as little as 2 years, and cost effectiveness improved over longer periods.
The investigators concluded that the budgetary impact of using thrombolysis with alteplase for acute ischaemic stroke via telemedicine depends on the existing capacity and organisational conditions at the local hospitals. The health economic model computations suggest that the macroeconomic costs may balance with savings in care and rehabilitation after as little as 2 years.
"Potentially large long-term savings are associated with thrombolysis with alteplase delivered by telemedicine", they concluded.
Reference:
Ehlers et al. CNS Drugs 2008, 22(1):73-81
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