Abstract
Introduction: stroke is a major public health problem in Colombia, is the third leading cause of death and second of potential life years lost. rt-PA has proven its cost-effectiveness in the treatment of ischaemic stroke .-
Patients and methods: to estimate the cost-effectiveness of thrombolytic therapy, usual therapy was compared against the application of usual therapy and rt-PA, cost treatments was calculate. The cost of both: hemorrhagic complications, acute and chronic disability was done in Colombian pesos based on a current price in national
health system, life expectancy was calculated too for a typical stroke patient. Given that in Colombia there are no studies of thrombolytic theraphy we extracted data from trials with rt-PA and placebo-controlled, and also analyzed some meta-analysis on this subject.
Results: although the cost of usual therapy is less than the combined therapy, this one is more effective and it provides a better cost-efectiveness (difference of 1.07 years of life QALYS adjusted), meaning that for each year of life, the national healt system must invest $ 1,138,373 pesos, as demonstrated in the sensitivity analysis performed for these findings.-
Conclusion: thrombolysis with rt-PA is cost-effective in Colombia, with current prices of health system in differents sensitivity analysis.-
References
Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020: Global Burden of Disease Study. Lancet 1997, 349: 1498-1504.
Feigin VL. Stroke epidemiology in the developing world. Lancet 2005; 365(9478): 2160-2161.
Feigin VL, Lawes CM, Bennett DA, Anderson CS. Stroke epidemiology: a review of population- based studies of incidence, prevalence, and case-fatality in the late 20th century. Lancet Neurol 2003, 2: 43-53.
Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998, 97: 596-601.
Colombia Ministerio de Salud Pública. La salud en Colombia. Bogotá: Ministerio de Salud. Bogotá: 1990: 595-597
Escobar M, Gallardo I, Giraldo P, Londoño JP. La carga de la enfermedad en Colombia. Ministerio de Salud. Bogotá: 1994.
Muñoz M, De Bastos M, Dávila J, Pedraza OL, Chávez F, Benzadón A, Medina MT. Registro latinoamericano de ACV/Ictus (RELACV). Un estudio piloto Sociedad Iberoamericana de ECV y Comité para el Estudio de la ECV de la Asociación Colombiana de Neurología: poster presentado en el VI Congreso Colombiano de Neurología. http://publicaciones.acnweb.org/acta/2003_19_3_163.pdf
Uribe CS, Jimenez I, Mora MO, Arana A, Sánchez JL, Zuluaga L, et al. Epidemiología de las enfermedades cerebrovasculares en Sabaneta, Colombia (1992-1993). Rev Neurol 1997; 25: 1008-1012.
Dobkin B: The economic impact of stroke. Neurology 1995; 45 Suppl:S6- S9.
Taylor TN, Davis PH, Torner JC, Holmes J, Meyer JW, Jacobson MF: Lifetime cost of stroke in the United States. Stroke 1996; 27: 1459-1466.
The NINDS: Tissue Plasmynogen Activator for Acute Ischemic Stroke. N Engl J Med 1995; 333: 1581-1587.
Hacke W, Kaste M, Fieschi C, et al. Intravenous thrombolysis with recombinant tissue plasminogen activator for acute hemispheric stroke: the European Cooperative Acute Stroke Study (ECASS). JAMA 1995; 274: 1017-1025.
Albers GW. ATLANTIS Trial: Results for Patients Treated Within 3 Hours of Stroke Onset, Editorial Comment: Results for Patients Treated Within 3 Hours of Stroke Onset. Stroke 2002; 33: 493-496.
Clark WM. The rt-PA (Alteplase) 0- to 6-Hour Acute Stroke Trial, Part A (A0276g): Results of a Double-Blind, Placebo-Controlled, Multicenter Study. Stroke 2000;31;811-816.
The ATLANTIS, ECASS, and NINDS rt-PA Study Group Investigators. Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. The Lancet 2004; 363: 768-774.
The NINDS rt-PA Stroke Study J.R. Marler: Early stroke treatment associated with better outcome. Neurology 2000; 55: 1649-1655.
Marler JR, Tilley BC, Lu M, et al. Early stroke treatment associated with better outcome: the NINDS rt-PA study. Neurology 2000; 55: 1649-1655.
Subgroup Analysis of the NINDS t-PA Stroke Trial, Generalized Efficacy of t-PA for Acute Stroke. Stroke 1997; 28: 2119-2125.
Kwiatkoski TG, Libman RB, Frankel M, et al. Effects of tissue plasminogen activator for acute ischemic stroke at one year. N Engl J Med 1999; 340: 1781-1783.
The National Institute of Neurological Disorders Stroke rt-PA Stroke Study Group: Recombinant Tissue Plasminogen Activator for Minor Strokes. Ann Emerg Med 2005; 46: 243-252.
Pantano P. Delayed Increase in Infarct Volume After Cerebral Ischemia: Correlations with Thrombolytic Treatment and Clinical Outcome. Stroke 1999; 30: 502-507.
NINDS. Effect of Intravenous Recombinant Tissue Plasminogen Activator on Ischemic Stroke Lesion Size Measured by Computed Tomography. Stroke 2000; 31: 2912-2919.
Dick AP, et al. IV tPA for Acute Ischemic Stroke Results of the First 101 Patients in a Community Practice. The Neurologist 2005; 11: 305-308
Hacke W, Kaste, M, Bluhmki E, for the ECASS Investigators. Thrombolysis with Alteplase 3 to 4.5 Hours after Acute Ischemic Stroke. NEJM 2008; 359: 1317-1329.
Fiorelli M. Hemorrhagic Transformation Within 36 Hours of a Cerebral Infarct Relationships With Early Clinical Deterioration and 3-Month Outcome in the European Cooperative Acute Stroke Study I (ECASS I) Cohort. Stroke 1999; 30: 2280-2284.
Berrouschot J, Röther J, Glahn J, et al. Outcome and Severe Hemorrhagic Complications of Intravenous Thrombolysis With Tissue Plasminogen Activator in Very Old (>80 Years) Stroke Patients. Stroke 2005; 36: 2421-2425.
Kent DM. In Acute Ischemic Stroke, Are Asymptomatic Intracranial Hemorrhages Clinically Innocuous? Stroke 2003; 34:1437-1442.
Grotta JC. Clinical Deterioration Following Improvement in the NINDS rt-PA Stroke Trial. Stroke 2001; 32: 661-668.
Demaerschalk BM, Yip TR, Todd R. Economic Benefit of Increasing Utilization of Intravenous Tissue Plasminogen Activator for Acute Ischemic Stroke in the United States Bart M. Stroke 2005; 36: 2500-2503.
Fagan SC, PharmD, Morgenstern, LB and the NINDS rt-PA Stroke Study Group: Cost-effectiveness of tissue plasminogen activator for acute ischemic stroke. Neurology 1998; 50: 883-890.
http://www.consortstatement.org/mod_ product/uploads/ CONSORT por ciento202001 por ciento20 checklist.do
Graham GD. Tissue Plasminogen Activator for Acute Ischemic Stroke in Clinical Practice: A Meta-Analysis of Safety Data. Stroke 2003; 34: 2847-2850.
Frey JL. Recombinant Tissue Plasminogen Activator (rt-PA) for Stroke The Perspective at 8 Years. The Neurologist 2005; 11: 123-133
Wardlaw JM. Thrombolytic Therapy With Recombinant Tissue Plasminogen Activator for Acute Ischemic Stroke: Where Do We Go From Here? A Cumulative Meta-Analysis. Stroke 2003;34;1437-1442.
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