Please use this identifier to cite or link to this item: https://repository.southwesthealthcare.com.au/swhealthcarejspui/handle/1/3844
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dc.contributor.authorGao, Lan-
dc.contributor.authorMoodie, Marj-
dc.contributor.authorMitchell, Peter J.-
dc.contributor.authorChurilov, Leonid-
dc.contributor.authorKleinig, Timothy J.-
dc.contributor.authorYassi, Nawaf-
dc.contributor.authorYan, Bernard-
dc.contributor.authorParsons, Mark W.-
dc.contributor.authorDonnan, Geoffrey A.-
dc.contributor.authorDavis, Stephen M.-
dc.contributor.authorCampbell, Bruce C. V.-
dc.contributor.authorEXTEND-IA TNK Investigators-
dc.date.accessioned2023-04-24T02:44:19Z-
dc.date.available2023-04-24T02:44:19Z-
dc.date.issued2020-
dc.identifier.urihttps://repository.southwesthealthcare.com.au/swhealthcarejspui/handle/1/3844-
dc.description.abstractBACKGROUND AND PURPOSE: Tenecteplase improved functional outcomes and reduced the requirement for endovascular thrombectomy in ischemic stroke patients with large vessel occlusion in the EXTEND-IA TNK randomized trial. We assessed the cost-effectiveness of tenecteplase versus alteplase in this trial. METHODS: Post hoc within-trial economic analysis included costs of index emergency department and inpatient stroke hospitalization, rehabilitation/subacute care, and rehospitalization due to stroke within 90 days. Sources for cost included key study site complemented by published literature and government websites. Quality-adjusted life-years were estimated using utility scores derived from the modified Rankin Scale score at 90 days. Long-term modeled cost-effectiveness analysis used a Markov model with 7 health states corresponding to 7 modified Rankin Scale scores. Probabilistic sensitivity analyses were performed. RESULTS: Within the 202 patients in the randomized controlled trial, total cost was nonsignificantly lower in the tenecteplase-treated patients (40 997 Australian dollars [AUD]) compared with alteplase-treated patients (46 188 AUD) for the first 90 days(P=0.125). Tenecteplase was the dominant treatment strategy in the short term, with similar cost (5412 AUD [95% CI, -13 348 to 2523]; P=0.181) and higher benefits (0.099 quality-adjusted life-years [95% CI, 0.001-0.1967]; P=0.048), with a 97.4% probability of being cost-effective. In the long-term, tenecteplase was associated with less additional lifetime cost (96 357 versus 106 304 AUD) and greater benefits (quality-adjusted life-years, 7.77 versus 6.48), and had a 100% probability of being cost-effective. Both deterministic sensitivity analysis and probabilistic sensitivity analyses yielded similar results. CONCLUSIONS: Both within-trial and long-term economic analyses showed that tenecteplase was highly likely to be cost-effective for patients with acute stroke before thrombectomy. Recommending the use of tenecteplase over alteplase could lead to a cost saving to the healthcare system both in the short and long term. Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT02388061.-
dc.relation.isversionof20201007-
dc.subjectCombined Modality Therapy-
dc.subjectCost-Benefit Analysis-
dc.subjectEmergency Service-
dc.subjectEndovascular Procedures-
dc.subjectFibrinolytic Agents-
dc.subjectHospitalization-
dc.subjectHumans-
dc.subjectIschemic Stroke-
dc.subjectMarkov Chains-
dc.subjectMortality-
dc.subjectPatient Readmission-
dc.subjectQuality-Adjusted Life Years-
dc.subjectRandomized Controlled Trials as Topic-
dc.subjectRecurrence-
dc.subjectStroke Rehabilitation-
dc.subjectTenecteplase-
dc.subjectThrombectomy-
dc.subjectTissue Plasminogen Activator-
dc.subjectUnited States-
dc.subjectInfarction-
dc.subjectStroke-
dc.subjectTenecteplase-
dc.subjectThrombectomy-
dc.titleCost-Effectiveness of Tenecteplase Before Thrombectomy for Ischemic Stroke-
dc.typeJournal Article-
dc.identifier.journaltitleStroke-
dc.accession.number33023423-
dc.identifier.urlhttps://www.ncbi.nlm.nih.gov/pubmed/33023423-
dc.description.affiliationDeakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Melbourne, Australia (L.G., M.M.).-
dc.description.affiliationDepartment of Radiology, Royal Melbourne Hospital (P.J.M.), University of Melbourne, Parkville, Australia.-
dc.description.affiliationDepartment of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital (L.C., N.Y., B.Y., M.W.P., G.A.D., S.M.D., B.C.V.C.), University of Melbourne, Parkville, Australia.-
dc.description.affiliationDepartment of Medicine, Austin Health, University of Melbourne, Heidelberg, Australia (L.C.).-
dc.description.affiliationDepartment of Neurology, Royal Adelaide Hospital, South Australia, Australia (T.J.K.).-
dc.description.affiliationFlorey Institute of Neuroscience and Mental Health (N.Y., B.C.V.C.), University of Melbourne, Parkville, Australia.-
dc.description.affiliationPopulation Health and Immunity Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia (N.Y.).-
dc.format.startpage3681-3689-
dc.source.volume51-
local.issue.number12-
dc.identifier.noteseng-
dc.identifier.notes2020/10/08-
dc.identifier.notesStroke. 2020 Dec;51(12):3681-3689. doi: 10.1161/STROKEAHA.120.029666. Epub 2020 Oct 7.-
dc.identifier.importdoi10.1161/STROKEAHA.120.029666-
dc.identifier.dateDec-
dc.identifier.date2020-
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