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- Title
Custo-efetividade de alteplase no tratamento de acidente vascular cerebral isquêmico até 4,5 horas após início dos sintomas: perspectiva do Sistema Único de Saúde do Brasil (SUS).
- Authors
Barbosa Campos, Daniela; Ouriques Martins, Sheila Cristina; Safanelli, Juliana; Bolzachini Santoni, Natália; Rita Aguirre, Anna; Zago Marcolino, Miriam Allein; Antonini Ribeiro, Rodrigo
- Abstract
Objective: To assess the cost-effectiveness of thrombolysis with alteplase for the treatment of acute ischemic stroke up to 4.5 hours after the onset of symptoms as compared to conservative medical treatment from the perspective of the Brazilian Public Health System. Methods: A Markov model was used to simulate the treatment of acute stroke and the associated short- and long-term consequences. Cost-effectiveness (life-years gained, LYG) and cost-utility (quality-adjusted life years, QALY) analyses were performed considering a lifetime horizon. Efficacy and safety parameters were obtained from a meta-analysis of individual data, considering treatment within 3 hours and 3-4.5 hours after the onset of symptoms. Acute and chronic costs were derived from a secondary analysis of data obtained from a Brazilian public hospital and expressed in Brazilian reais (R$). Probabilistic and deterministic sensitivity analyses were performed. The willingness to pay threshold (WPT) was established as 1 GDP per capita for 2019 in Brazil (R$ 31,833.50). Results: Treatment with alteplase vs. conservative medical treatment was associated with an increase of 0.22 in LYG, 0.32 in QALY, and R$ 4,320.12 in cost. The incremental cost-effectiveness ratio (ICER) was estimated as R$ 19,996.43/LYG and R$ 13,383.64/QALY. Variations in effectiveness and costs of acute alteplase treatment had the greatest impact on sensitivity analyses. Considering ICER/LYG and ICER/QALY, 70.7% and 93.1% of the simulations in probabilistic sensitivity analysis were below the WPT, respectively. Conclusions: Treatment with alteplase up to 4.5 hours after the onset of symptoms has a high probability of being cost-effective from the perspective of the Brazilian Public Health System.
- Subjects
BRAZIL; QUALITY-adjusted life years; TISSUE plasminogen activator; WILLINGNESS to pay; THERAPEUTICS; MARKOV processes
- Publication
JBES: Brazilian Journal of Health Economics / Jornal Brasileiro de Economia da Saúde, 2020, Vol 12, Issue 3, p241
- ISSN
2175-2095
- Publication type
Article
- DOI
10.21115/JBES.v12.n3.p241-54