IHRC Inc., Atlanta, GA.
Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention (CDC) Atlanta, GA.
Stroke Vasc Neurol. 2017;2(2):73-83. doi: 10.1136/svn-2016-000063. Epub 2017 Apr 28.
Intravenous recombinant tissue plasminogen activator (IV rtPA) is recommended treatment for acute ischemic stroke patients, but the cost-effectiveness of IV rtPA within different time windows after the onset of acute ischemic stroke is not well reviewed.
To conduct a literature review of the cost-effectiveness studies about IV rtPA by treatment times.
A literature search was conducted using MEDLINE, EMBASE, CINAHL and Cochrane Library, with the key words and . The review is limited to original research articles published during 1995-2016 in English-language peer-reviewed journals. We found 16 studies meeting our criteria for this review. Nine of them were cost-effectiveness studies of IV rtPA treatment within 0-3 hours after stroke onset, 2 studies within 3-4.5 hours, 3 studies within 0-4.5 hours, and 2 study within 0-6 hours. IV rtPA is a cost-saving or a cost-effectiveness strategy from most of the study results. Only one study showed incremental cost-effectiveness ratio of IV rtPA within one year was marginally above $50,000 per QALY threshold. IV rtPA within 0-3 hours after stroke led to cost savings for lifetime or 30 years, and IV rtPA within 3-4.5 hours after stroke increased costs but still was cost-effective.
The literature generally showed that intravenous IV rtPA was a dominant or a cost-effective strategy compared to traditional treatment for acute ischemic stroke patients without IV rtPA. The findings from the literature lacked generalizability because of limited data and various assumptions.
静脉注射重组组织型纤溶酶原激活剂（IV rtPA）是急性缺血性脑卒中患者的推荐治疗方法，但 IV rtPA 在急性缺血性脑卒中发病后不同时间窗内的成本效益尚未得到充分评估。
对按治疗时间进行 IV rtPA 成本效益研究的文献进行综述。
使用 MEDLINE、EMBASE、CINAHL 和 Cochrane Library 进行文献检索，关键词为“急性缺血性脑卒中”和“重组组织型纤溶酶原激活剂”。本综述仅限于 1995 年至 2016 年期间以英文发表的同行评审期刊中的原始研究文章。我们共找到了 16 项符合本综述标准的研究。其中 9 项是关于发病后 0-3 小时内 IV rtPA 治疗的成本效益研究，2 项是关于发病后 3-4.5 小时内的研究，3 项是关于 0-4.5 小时内的研究，2 项是关于发病后 0-6 小时内的研究。大多数研究结果表明，IV rtPA 是一种节省成本或具有成本效益的策略。只有一项研究显示，在一年内，IV rtPA 的增量成本效益比略高于每 QALY 50,000 美元的阈值。发病后 0-3 小时内使用 IV rtPA 可实现终生或 30 年的成本节约，而发病后 3-4.5 小时内使用 IV rtPA 会增加成本，但仍具有成本效益。
文献普遍表明，与未使用 IV rtPA 的传统治疗相比，IV rtPA 是急性缺血性脑卒中患者的主导或具有成本效益的治疗策略。由于数据有限和各种假设，文献中的研究结果缺乏普遍性。
