Intravenous Thrombolytic Treatment After Acute Stroke and Secondary Antithrombotic Prevention Treatment (Antiplatelet and Anticoagulant Treatment) After Stroke [Internet]

Excerpt

Background Stroke is the third most common cause of death, a major cause of severe disability and accounts for considerable consumption of healthcare resources. Which medication should be chosen for the treatment of stroke depends on several factors, including efficiency and price.

Task requirement The Norwegian Directorate of Health’s development groups for the preparation of national clinical guideline for stroke have commissioned the Norwegian Knowledge Centre for the Health Services to conduct economic evaluations of some central recommendations in the stroke guideline. We evaluated the clinical efficacy and conducted health economic evaluation of: 1. Intravenous thrombolytic treatment of patients with acute stroke (within 3 hours and between 3 to 5 hours after symptom onset) in addition to standard treatment compared to treatment without thrombolysis 2. Pharmacological secondary prevention of stroke

1. Antiplatelet therapy: acetylsalicylic acid (ASA) combined with slow-release dipyridamole compared with ASA monotherapy

2. Antiplatelet therapy: ASA combined with slow-release dipyridamole compared with clopidogrel monotherapy

3. Anticoagulation therapy with warfarin compared with ASA for prophylaxis of stroke in patients with atrial fibrillation

Main Results

1. Thrombolytic treatment within 3 hours after stoke reduces lifetime costs and adds quality-adjusted life years (QALYs) compared with standard treatment without thrombolysis for selected stroke patients.

2. Thrombolysis given between 3 and 5 hours after stroke is cost-effective compared to no thrombolytic treatment. However, the choice of thrombolysis in this time interval should also be carefully considered from an ethical perspective, because it leads to shorter life expectancy relative to no thrombolytic treatment.

3. The combination of ASA and extended-release dipyridamole increases QALYs and reduces lifetime costs compared with ASA monotherapy in secondary prevention of stroke.

4. The use of ASA combined with slow-release dipyridamole for patients of 70 years reduces lifetime costs and adds QALYs compared to clopidogrel for secondary prevention of stroke.

5. Anticoagulation therapy with warfarin has lower expected costs and higher expected QALYs compared with ASA therapy for stroke patients with atrial fibrillation.

Keywords: Technology Assessment, Biomedical; Stroke; Secondary Prevention; Administration, Intravenous; Thrombolytic Therapy; Aspirin; Dipyridamole; clopidogrel; Warfarin; Pharmaceutical Preparations; Economics, Pharmaceutical; Economics, Medical; Cost-Benefit Analysis.