Te Ao Braden, Brown Paul, Fink John, Vivian Mark, Feigin Valery
National Institute for Stroke and Applied Neurosciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Auckland, New Zealand.
School of Social Science, Humanities and Arts, University of California, Merced, CA, USA.
Int J Stroke. 2015 Aug;10(6):903-10. doi: 10.1111/ijs.12152. Epub 2013 Nov 10.
Treatment of ischemic stroke patients with tissue-type plasminogen activator (tPA) is known to be effective and cost-effective, yet the percentage of patients treated with thrombolysis in hospitals remains low. The purpose of this study is to examine whether providing thrombolysis in New Zealand hospitals is currently cost-effective and to estimate the amount that might be spent on campaigns aimed at increasing thrombolysis receipt rates.
A decision-analytic model was developed and populated using health services data from the literature and the Auckland Regional Community Stroke Outcome Study. The cost-utilities of providing thrombolysis over one-year and patient lifetime were estimated. Using a threshold of NZ$20 000 (US$15 337) per quality-adjusted life year, the analysis identified the maximum amount that might be spent on campaigns aiming to increase rates of receipt of thrombolysis above their current levels. Monte Carlo simulations and probabilistic sensitivity analysis explored the robustness of the findings.
Providing thrombolysis was cost-effective, especially when long-term costs and effects were considered (NZ$6641 or US$5093 per quality-adjusted life year). The results suggest that better management within hospitals would be more effective in increasing thrombolysis receipt rates (up to 17%) than campaigns aiming at higher awareness of stroke symptoms in the community. The amount that might be spent on a national campaign to increase rate of receipt of thrombolysis from its current level (3% of eligible patients) depended upon the effectiveness of the campaign, ranging from under NZ$6 million for New Zealand for an increase in rate to 30% to over $9 million for an increase in rate to 50%.
While thrombolysis is a cost-effective treatment in New Zealand, resources should be devoted to campaigns, both within hospitals and in the community, to increase coverage.
已知使用组织型纤溶酶原激活剂（tPA）治疗缺血性中风患者具有有效性和成本效益，但医院中接受溶栓治疗的患者比例仍然较低。本研究的目的是检验在新西兰医院提供溶栓治疗目前是否具有成本效益，并估计可能用于旨在提高溶栓治疗接受率的宣传活动的费用。
利用文献中的卫生服务数据和奥克兰地区社区中风结局研究开发并填充了一个决策分析模型。估计了提供一年期和患者终身溶栓治疗的成本效用。使用每质量调整生命年20000新西兰元（15337美元）的阈值，该分析确定了可能用于旨在将溶栓治疗接受率提高到当前水平以上的宣传活动的最大费用。蒙特卡罗模拟和概率敏感性分析探讨了研究结果的稳健性。
提供溶栓治疗具有成本效益，特别是在考虑长期成本和效果时（每质量调整生命年6641新西兰元或5093美元）。结果表明，医院内更好的管理在提高溶栓治疗接受率（高达17%）方面比旨在提高社区中风症状知晓率的宣传活动更有效。用于全国性宣传活动以将溶栓治疗接受率从当前水平（符合条件患者的3%）提高的费用取决于宣传活动的有效性，从新西兰不到600万美元将接受率提高到30%到超过900万美元将接受率提高到50%不等。
虽然溶栓治疗在新西兰是一种具有成本效益的治疗方法，但应将资源投入到医院内部和社区的宣传活动中，以提高覆盖率。
