Cost-Effectiveness of Tenecteplase Before Thrombectomy for Ischemic Stroke

Stroke. 2020 Dec;51(12):3681-3689. doi: 10.1161/STROKEAHA.120.029666. Epub 2020 Oct 7.


Background and purpose: Tenecteplase improved functional outcomes and reduced the requirement for endovascular thrombectomy in ischemic stroke patients with large vessel occlusion in the EXTEND-IA TNK randomized trial. We assessed the cost-effectiveness of tenecteplase versus alteplase in this trial.

Methods: Post hoc within-trial economic analysis included costs of index emergency department and inpatient stroke hospitalization, rehabilitation/subacute care, and rehospitalization due to stroke within 90 days. Sources for cost included key study site complemented by published literature and government websites. Quality-adjusted life-years were estimated using utility scores derived from the modified Rankin Scale score at 90 days. Long-term modeled cost-effectiveness analysis used a Markov model with 7 health states corresponding to 7 modified Rankin Scale scores. Probabilistic sensitivity analyses were performed.

Results: Within the 202 patients in the randomized controlled trial, total cost was nonsignificantly lower in the tenecteplase-treated patients (40 997 Australian dollars [AUD]) compared with alteplase-treated patients (46 188 AUD) for the first 90 days(P=0.125). Tenecteplase was the dominant treatment strategy in the short term, with similar cost (5412 AUD [95% CI, -13 348 to 2523]; P=0.181) and higher benefits (0.099 quality-adjusted life-years [95% CI, 0.001-0.1967]; P=0.048), with a 97.4% probability of being cost-effective. In the long-term, tenecteplase was associated with less additional lifetime cost (96 357 versus 106 304 AUD) and greater benefits (quality-adjusted life-years, 7.77 versus 6.48), and had a 100% probability of being cost-effective. Both deterministic sensitivity analysis and probabilistic sensitivity analyses yielded similar results.

Conclusions: Both within-trial and long-term economic analyses showed that tenecteplase was highly likely to be cost-effective for patients with acute stroke before thrombectomy. Recommending the use of tenecteplase over alteplase could lead to a cost saving to the healthcare system both in the short and long term. Registration: URL: Unique identifier: NCT02388061.

Keywords: cost-benefit analysis; infarction; stroke; tenecteplase; thrombectomy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Combined Modality Therapy
  • Cost-Benefit Analysis
  • Emergency Service, Hospital / economics
  • Endovascular Procedures
  • Fibrinolytic Agents / economics*
  • Fibrinolytic Agents / therapeutic use
  • Hospitalization / economics*
  • Humans
  • Ischemic Stroke / physiopathology
  • Ischemic Stroke / therapy*
  • Markov Chains
  • Mortality*
  • Patient Readmission / economics
  • Patient Readmission / statistics & numerical data
  • Quality-Adjusted Life Years*
  • Randomized Controlled Trials as Topic
  • Recurrence
  • Stroke Rehabilitation / economics
  • Tenecteplase / economics*
  • Tenecteplase / therapeutic use
  • Thrombectomy*
  • Tissue Plasminogen Activator / economics*
  • Tissue Plasminogen Activator / therapeutic use
  • United States


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator
  • Tenecteplase

Associated data