Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients
Objectives 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...
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| Veröffentlicht in: | The European journal of health economics 2023-06, Vol.24 (4), p.621-632 |
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| creator | Parody-Rua, Elizabeth Bustamante, Alejandro Montaner, Joan Rubio-Valera, Maria Serrano, David Pérez-Sánchez, Soledad Sánchez-Viñas, Alba Guevara-Cuellar, César Serrano-Blanco, Antoni |
| description | Objectives
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.
Methods
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.
Results
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.
Conclusions
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. |
| doi_str_mv | 10.1007/s10198-022-01495-1 |
| format | Article |
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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.
Methods
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.
Results
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.
Conclusions
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.</description><identifier>ISSN: 1618-7598</identifier><identifier>EISSN: 1618-7601</identifier><identifier>DOI: 10.1007/s10198-022-01495-1</identifier><identifier>PMID: 35896861</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Adult ; Biomarkers ; Blood ; Cost-Benefit Analysis ; Costs ; Economic Policy ; Fibrinolytic Agents - therapeutic use ; Health Care Management ; Health Economics ; Hospitals ; Humans ; Ischemia ; Markov chains ; Medicine ; Medicine & Public Health ; Original Paper ; Pharmacoeconomics and Health Outcomes ; Public Finance ; Public Health ; Quality-Adjusted Life Years ; Sensitivity analysis ; Stroke ; Stroke - drug therapy ; Thrombolytic Therapy</subject><ispartof>The European journal of health economics, 2023-06, Vol.24 (4), p.621-632</ispartof><rights>The Author(s) 2022</rights><rights>2022. The Author(s).</rights><rights>The Author(s) 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c565t-6e6f286972d148c7d12dc01c5d242a2ac63c96a533ade53784be88c1fdf9a0423</citedby><cites>FETCH-LOGICAL-c565t-6e6f286972d148c7d12dc01c5d242a2ac63c96a533ade53784be88c1fdf9a0423</cites><orcidid>0000-0001-5020-7534 ; 0000-0003-4390-8900 ; 0000-0001-6123-0633 ; 0000-0002-8940-9763 ; 0000-0003-2856-1697 ; 0000-0001-8219-2568 ; 0000-0003-4845-2279 ; 0000-0002-4412-0261</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10198-022-01495-1$$EPDF$$P50$$Gspringer$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10198-022-01495-1$$EHTML$$P50$$Gspringer$$Hfree_for_read</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35896861$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Parody-Rua, Elizabeth</creatorcontrib><creatorcontrib>Bustamante, Alejandro</creatorcontrib><creatorcontrib>Montaner, Joan</creatorcontrib><creatorcontrib>Rubio-Valera, Maria</creatorcontrib><creatorcontrib>Serrano, David</creatorcontrib><creatorcontrib>Pérez-Sánchez, Soledad</creatorcontrib><creatorcontrib>Sánchez-Viñas, Alba</creatorcontrib><creatorcontrib>Guevara-Cuellar, César</creatorcontrib><creatorcontrib>Serrano-Blanco, Antoni</creatorcontrib><title>Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients</title><title>The European journal of health economics</title><addtitle>Eur J Health Econ</addtitle><addtitle>Eur J Health Econ</addtitle><description>Objectives
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.
Methods
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.
Results
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.
Conclusions
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.</description><subject>Adult</subject><subject>Biomarkers</subject><subject>Blood</subject><subject>Cost-Benefit Analysis</subject><subject>Costs</subject><subject>Economic Policy</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Health Care Management</subject><subject>Health Economics</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Markov chains</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Original Paper</subject><subject>Pharmacoeconomics and Health Outcomes</subject><subject>Public Finance</subject><subject>Public Health</subject><subject>Quality-Adjusted Life Years</subject><subject>Sensitivity analysis</subject><subject>Stroke</subject><subject>Stroke - drug therapy</subject><subject>Thrombolytic Therapy</subject><issn>1618-7598</issn><issn>1618-7601</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kctu1TAQhiMEoqXwAiyQJTZsAh4nvmSFUMVNatVNWVuOPTnHbU4cbKfSWfHq-JBeoAs2HkvzzT-Xv6peA30PlMoPCSh0qqaM1RTajtfwpDoGAaqWgsLTuz_v1FH1IqUrWkjJmufVUcNVJ5SA4-rXeXA4-mlD8hbJHDJO2ZuR4DB463GyexIGYkg_huBI78POxGuMdW8SOpJDGMtDNot3pTpivQ1p9rkI5G0Muz6M--ztQTuaeU_8RFKO4bqwJhf1nF5WzwYzJnx1G0-qH18-X55-q88uvn4__XRWWy54rgWKgSnRSeagVVY6YM5SsNyxlhlmrGhsJwxvGuOQN1K1PSplYXBDZ2jLmpPq46o7L_0OnS29oxn1HH1ZaK-D8frfzOS3ehNudLmx5C3visK7W4UYfi6Yst75ZHEczYRhSZqJTlAqJJMFffsIvQpLnMp-milgTEhgUCi2UjaGlCIO99MA1QeD9WqwLrbpPwbrQ9Gbv_e4L7lztABkBdCGyacHTVUO2QBr24I0K5JKctpgfBjvP51_A96qvjU</recordid><startdate>20230601</startdate><enddate>20230601</enddate><creator>Parody-Rua, Elizabeth</creator><creator>Bustamante, Alejandro</creator><creator>Montaner, Joan</creator><creator>Rubio-Valera, Maria</creator><creator>Serrano, David</creator><creator>Pérez-Sánchez, Soledad</creator><creator>Sánchez-Viñas, Alba</creator><creator>Guevara-Cuellar, César</creator><creator>Serrano-Blanco, Antoni</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>OQ6</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7WY</scope><scope>7WZ</scope><scope>7X7</scope><scope>7XB</scope><scope>87Z</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FL</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BEZIV</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FRNLG</scope><scope>FYUFA</scope><scope>F~G</scope><scope>GHDGH</scope><scope>K60</scope><scope>K6~</scope><scope>K9.</scope><scope>L.-</scope><scope>M0C</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>PQBIZ</scope><scope>PQBZA</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PYYUZ</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-5020-7534</orcidid><orcidid>https://orcid.org/0000-0003-4390-8900</orcidid><orcidid>https://orcid.org/0000-0001-6123-0633</orcidid><orcidid>https://orcid.org/0000-0002-8940-9763</orcidid><orcidid>https://orcid.org/0000-0003-2856-1697</orcidid><orcidid>https://orcid.org/0000-0001-8219-2568</orcidid><orcidid>https://orcid.org/0000-0003-4845-2279</orcidid><orcidid>https://orcid.org/0000-0002-4412-0261</orcidid></search><sort><creationdate>20230601</creationdate><title>Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients</title><author>Parody-Rua, Elizabeth ; Bustamante, Alejandro ; Montaner, Joan ; Rubio-Valera, Maria ; Serrano, David ; Pérez-Sánchez, Soledad ; Sánchez-Viñas, Alba ; Guevara-Cuellar, César ; Serrano-Blanco, Antoni</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c565t-6e6f286972d148c7d12dc01c5d242a2ac63c96a533ade53784be88c1fdf9a0423</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Adult</topic><topic>Biomarkers</topic><topic>Blood</topic><topic>Cost-Benefit Analysis</topic><topic>Costs</topic><topic>Economic Policy</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Health Care Management</topic><topic>Health Economics</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Markov chains</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Original Paper</topic><topic>Pharmacoeconomics and Health Outcomes</topic><topic>Public Finance</topic><topic>Public Health</topic><topic>Quality-Adjusted Life Years</topic><topic>Sensitivity analysis</topic><topic>Stroke</topic><topic>Stroke - drug therapy</topic><topic>Thrombolytic Therapy</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Parody-Rua, Elizabeth</creatorcontrib><creatorcontrib>Bustamante, Alejandro</creatorcontrib><creatorcontrib>Montaner, Joan</creatorcontrib><creatorcontrib>Rubio-Valera, Maria</creatorcontrib><creatorcontrib>Serrano, David</creatorcontrib><creatorcontrib>Pérez-Sánchez, Soledad</creatorcontrib><creatorcontrib>Sánchez-Viñas, Alba</creatorcontrib><creatorcontrib>Guevara-Cuellar, César</creatorcontrib><creatorcontrib>Serrano-Blanco, Antoni</creatorcontrib><collection>Springer_OA刊</collection><collection>ECONIS</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Access via ABI/INFORM (ProQuest)</collection><collection>ABI/INFORM Global (PDF only)</collection><collection>ProQuest - 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Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The European journal of health economics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Parody-Rua, Elizabeth</au><au>Bustamante, Alejandro</au><au>Montaner, Joan</au><au>Rubio-Valera, Maria</au><au>Serrano, David</au><au>Pérez-Sánchez, Soledad</au><au>Sánchez-Viñas, Alba</au><au>Guevara-Cuellar, César</au><au>Serrano-Blanco, Antoni</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients</atitle><jtitle>The European journal of health economics</jtitle><stitle>Eur J Health Econ</stitle><addtitle>Eur J Health Econ</addtitle><date>2023-06-01</date><risdate>2023</risdate><volume>24</volume><issue>4</issue><spage>621</spage><epage>632</epage><pages>621-632</pages><issn>1618-7598</issn><eissn>1618-7601</eissn><abstract>Objectives
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.
Methods
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.
Results
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.
Conclusions
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.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>35896861</pmid><doi>10.1007/s10198-022-01495-1</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0001-5020-7534</orcidid><orcidid>https://orcid.org/0000-0003-4390-8900</orcidid><orcidid>https://orcid.org/0000-0001-6123-0633</orcidid><orcidid>https://orcid.org/0000-0002-8940-9763</orcidid><orcidid>https://orcid.org/0000-0003-2856-1697</orcidid><orcidid>https://orcid.org/0000-0001-8219-2568</orcidid><orcidid>https://orcid.org/0000-0003-4845-2279</orcidid><orcidid>https://orcid.org/0000-0002-4412-0261</orcidid><oa>free_for_read</oa></addata></record> |
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| ispartof | The European journal of health economics, 2023-06, Vol.24 (4), p.621-632 |
| issn | 1618-7598 1618-7601 |
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| subjects | Adult Biomarkers Blood Cost-Benefit Analysis Costs Economic Policy Fibrinolytic Agents - therapeutic use Health Care Management Health Economics Hospitals Humans Ischemia Markov chains Medicine Medicine & Public Health Original Paper Pharmacoeconomics and Health Outcomes Public Finance Public Health Quality-Adjusted Life Years Sensitivity analysis Stroke Stroke - drug therapy Thrombolytic Therapy |
| title | Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients |
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