Burden of Stroke in Italy: An Economic Model Highlights Savings Arising from Reduced Disability following Thrombolysis

• Published in: International journal of stroke 2015-08, Vol.10 (6), p.849-855
• Main Authors: Chiumente, M., Gianino, M. M., Minniti, D., Mattei, T. J., Spass, B., Kamal, K. M., Zimmerman, D. E., Muca, A., Luda, E.
• Format: Article
• Language: English
• Subjects: Brain Ischemia - drug therapy; Brain Ischemia - economics; Brain Ischemia - epidemiology; cost; Cost of Illness; disability; Disability Evaluation; Health Care Costs; Humans; Italy; Italy - epidemiology; Models, Economic; Multivariate Analysis; Sensitivity and Specificity; stroke; Stroke - drug therapy; Stroke - economics; Stroke - epidemiology; thrombolysis; Thrombolytic Therapy - economics; Thrombolytic Therapy - methods; Time Factors; tPA; Treatment Outcome
• ISSN: 1747-4930; 1747-4949
• DOI: 10.1111/ijs.12481

Background The consequences of stroke must be assessed not only in terms of incidence and mortality rates, but also in terms of disability, which may persist long after the acute phase. Thrombolysis, if timely administered, can effectively reduce post-stroke disability. Aims The economic model presented herein aims to evaluate, in eligible patients, the effects of alteplase on post-stroke disability and related costs over three-years. Methods The economic analysis was developed on the basis of four key components: clinical outcomes from international trials, economic consequences extracted from cost of illness studies, regulatory data from national and international agencies, and national epidemiological data. A population-level model estimated the difference in disability costs between patients treated with standard care versus those receiving thrombolytic therapy within 4×5 h of acute ischemic stroke. The analysis covered 36 months from discharge. Results Reduced costs related to post-stroke disability were observed in treated patients compared with those receiving standard care (control). The overall savings were ¢2330×15 per average patient: ¢1445×81 during the first 18 months, ¢362×25 between 18 and 24 months, and ¢522×09 in the 24–36 months period. The overall savings on 3174 Italian treated patients in 2013 were ¢7 395 907 over three-years. Conclusion Our study reveals that performing thrombolytic therapy in eligible patients improves economic outcomes compared with patients receiving standard care. This model is useful for decision makers, both within and outside of the Italian national context, as a tool to assess the cost-effectiveness of thrombolysis in both short- and long-term period.