Cost-Utility Analysis of Rhtnk-TPA Compared With RT-PA In The Treatment of Acute St-Segment Elevation Myocardial Infarction (Stemi) In China

OBJECTIVES: ST-segment elevation myocardial infarction (STEMI) is associated with significant increase in morbidity and mortality. Recombinant Human TNK Tissue-type Plasminogen Activator for Injection (rhTNK-tPA) is the latest generation proven effective thrombolysis strategy in STEMI treatment. Clinical study (Phase II trial) had demonstrated its thrombolysis efficacy. However, no studies have evaluated the economic impact of rhTNK-tPA in China in acute STEMI patients. The current study utilizes Chinese efficacy and cost data to evaluate cost utility of rhTNK-tPA versus rt-PA in STEMI patients to provide evidence for relevant medical decision making. METHODS: A decision-tree model, from the payer's perspective, was constructed to predict acute stage (30 days) and long-term (10 years)'s total cost and QALYs gained for rhTNK-tPA and rt-PA groups, respectively. Clinical efficacy, safety data and utility values were abstracted from the Phase II trial, published meta-analysis and literatures. Chinese local cost data is extracted from literature review and through a micro-costing study of 41 attending physicians at 7 tertiary hospitals located in representative cities of Beijing, Shanghai, Guangzhou, Foshan, Zhanjiang, Chengdu and Xi'an in China. RESULTS: The total cost for the rhTNK-tPA group in acute stage (30 days) and long-term (10 years) was 30,846 and 103,028.49, respectively, while the total cost for the rt-PA group was 31,314 and 103,030.36, respectively. The QALYs gained for the rhTNK-tPA group in acute stage (30 days) and long-term (10 years) was 0.0345 and 4.470, respectively, while the total QALYs gained for the rt-PA group was 0.0343 and 4.441, respectively. Compared with rt-PA, rhTNK-tPA is dominant in the treatment of acute STEMI with more QALY gained and lower overall cost. CONCLUSIONS: Compared with rt-PA, rhTNK-tPA is a cost-effective alternative in the treatment of acute STEMI both in acute stage and long-term in China.