Aref Hany, El Nahas Nevine, Elsisi Gihan Hamdy, Shokri Hossam, Roushdy Tamer
Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
HTA Office, LLC, Cairo, Egypt.
Front Neurol. 2023 Nov 8;14:1220615. doi: 10.3389/fneur.2023.1220615. eCollection 2023.
Stroke is the second leading cause of mortality worldwide. Five percent of all the disability-adjusted life years (DALYs) lost around the world are attributed to stroke. This study aimed to assess the economic burden of acute ischemic stroke (AIS) in Egypt and reveal the benefits of alteplase treatment by measuring the resource use and costs associated with this treatment compared to the standard of care and extrapolate the overall budget impact of alteplase to the local Egyptian setting over a 5-year time horizon from a societal perspective.
A budget impact model was developed to estimate the impact of adding alteplase to the current treatment of AIS patients within the Egyptian healthcare setting. The efficacy data for both arms of the model were sourced from a systematic review of the literature. Resource use and cost data were sourced from a retrospective study. Proportions of patients potentially eligible for treatment and the treatment time distributions were estimated from an analysis of the results of this retrospective data collection. A univariate sensitivity analysis was conducted to assess the robustness of the model results. The input parameters varied between plausible extremes based on a review of available evidence.
The total annual costs with alteplase treatment [i.e., drug, symptomatic intracerebral hemorrhage (ICH) management, acute hospitalization, and post-hospitalization costs] for the targeted patients from a societal perspective were estimated to be less than the total annual costs without alteplase. This resulted in savings of approximately EGP 37.2 million ($ 1.2 million), EGP 14.2 million ($ 458.06), EGP -33.0 million ($ -1.06 million), EGP -54.0 million ($ -1.74 million), and EGP -89.8 million ($ -2.89 million) for each of the 5 years, respectively. In year 1, more than 2,787 patients (+30.1%) achieved an excellent outcome and <1,204 patients (-22.3%) had a poor outcome when treated with alteplase. The savings in acute hospitalization and post-hospitalization costs offset the increase in drug and ICH management costs in the alteplase group compared to treatment without alteplase. The total cumulative cost savings for alteplase in AIS patients were estimated at EGP -228,146,871 ($ -7,359,576) over 5 years.
The budget impact model estimates suggest that from a societal perspective, alteplase is likely to be a cost-saving option for the treatment of AIS in Egypt due to the treatment benefits, resulting in savings in acute hospitalization and annual post-hospitalization costs.
中风是全球第二大致死原因。全球所有伤残调整生命年（DALYs）中有5%归因于中风。本研究旨在评估埃及急性缺血性中风（AIS）的经济负担，并通过衡量与该治疗相关的资源使用和成本，与标准治疗进行比较，揭示阿替普酶治疗的益处，并从社会角度推断阿替普酶在5年时间范围内对埃及当地环境的总体预算影响。
开发了一个预算影响模型，以估计在埃及医疗环境中，在AIS患者当前治疗方案中添加阿替普酶的影响。模型两组的疗效数据来自对文献的系统评价。资源使用和成本数据来自一项回顾性研究。通过对该回顾性数据收集结果的分析，估计了可能符合治疗条件的患者比例和治疗时间分布。进行了单变量敏感性分析，以评估模型结果的稳健性。根据现有证据的综述，输入参数在合理的极端值之间变化。
从社会角度来看，目标患者接受阿替普酶治疗的年度总成本[即药物、症状性脑出血（ICH）管理、急性住院和出院后成本]估计低于不使用阿替普酶的年度总成本。这导致在5年中，每年分别节省约3720万埃及镑（120万美元）、1420万埃及镑（45.806美元）、-3300万埃及镑（-106万美元）、-5400万埃及镑（-174万美元）和-8980万埃及镑（-289万美元）。在第1年，接受阿替普酶治疗时，超过2787名患者（+30.1%）获得了良好的结局，<1204名患者（-22.3%）结局不佳。与不使用阿替普酶的治疗相比，阿替普酶组急性住院和出院后成本的节省抵消了药物和ICH管理成本的增加。AIS患者使用阿替普酶的累计总成本节省估计在5年内为-228146871埃及镑（-7359576美元）。
预算影响模型估计表明，从社会角度来看，由于治疗益处，阿替普酶可能是埃及治疗AIS的一种节省成本的选择，可节省急性住院和年度出院后成本。
