Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain.
Primary Care Prevention and Health Promotion Network (redIAPP), Barcelona, Spain.
Eur J Health Econ. 2023 Jun;24(4):621-632. doi: 10.1007/s10198-022-01495-1. Epub 2022 Jul 27.
Stroke treatment with intravenous tissue-type plasminogen activator (tPA) is effective and efficient, but as its benefits are highly time dependent, it is essential to treat the patient promptly after symptom onset. This study evaluates the cost-effectiveness of a blood biomarker test to differentiate ischemic and hemorrhagic stroke to guide pre-hospital treatment with tPA in patients with suspected stroke, compared with standard hospital management. The standard care for patients suffering stroke consists mainly in diagnosis, treatment, hospitalization and monitoring.
A Markov model was built with four health states according to the modified Rankin scale, in adult patients with suspected moderate to severe stroke (NIHSS 4-22) within 4.5 hours after symptom onset. A Spanish Health System perspective was used. The time horizon was 15 years. Quality-adjusted life-years (QALYs) and life-years gained (LYGs) were used as a measure of effectiveness. Short- and long-term direct health costs were included. Costs were expressed in Euros (2022). A discount rate of 3% was used. Probabilistic sensitivity analysis and several one-way sensitivity analyses were conducted.
The use of a blood-test biomarker compared with standard care was associated with more QALYs (4.87 vs. 4.77), more LYGs (7.18 vs. 7.07), and greater costs (12,807€ vs. 12,713€). The ICER was 881€/QALY. Probabilistic sensitivity analysis showed that the biomarker test was cost-effective in 82% of iterations using a threshold of 24,000€/QALY.
The use of a blood biomarker test to guide pre-hospital thrombolysis is cost-effective compared with standard hospital care in patients with ischemic stroke.
静脉注射组织型纤溶酶原激活物（tPA）治疗脑卒中效果显著且高效，但由于其获益与时间密切相关，因此在患者出现症状后尽快进行治疗至关重要。本研究评估了一种血液生物标志物检测用于区分缺血性卒中和出血性卒中来指导疑似脑卒中患者接受 tPA 院前治疗的成本效益，与标准医院管理进行比较。脑卒中患者的标准治疗主要包括诊断、治疗、住院和监测。
采用 Markov 模型，根据改良 Rankin 量表，构建了四个健康状态，纳入发病 4.5 小时内疑似中重度脑卒中（NIHSS 4-22）的成年患者。采用西班牙卫生系统视角，时间范围为 15 年。使用质量调整生命年（QALYs）和生命年增加（LYGs）作为有效性的衡量指标。纳入了短期和长期直接健康成本。成本以欧元（2022 年）表示。使用 3%的贴现率。进行了概率敏感性分析和几种单项敏感性分析。
与标准治疗相比，使用血液检测生物标志物与更多的 QALYs（4.87 对 4.77）、更多的 LYGs（7.18 对 7.07）和更高的成本（12807 欧元对 12713 欧元）相关。ICER 为 881 欧元/QALY。概率敏感性分析表明，在使用 24000 欧元/QALY 阈值的情况下，该生物标志物检测在 82%的迭代中具有成本效益。
与标准医院治疗相比，在缺血性脑卒中患者中使用血液生物标志物检测来指导院前溶栓治疗具有成本效益。
