Poster The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Cost-effectiveness of Tenecteplase versus Alteplase for Pre-hospital Thrombolysis on the Melbourne Mobile Stroke Unit (#185)

Lan Gao 1 , Mark Parsons 2 , Leonid Churilov 3 , Henry Zhao 3 , Bruce Campbell 3 , Bernard Yan 3 , Peter Mitchell 4 , Skye Coote 3 , Francesca Langenberg 3 , Karen Smith 5 , David Anderson 6 , Michael Stephenson 5 , Stephen Davis 3 , Geoffrey Donnan 3 , Damien Easton 3 , Andrew Bivard 3
  1. Deakin University, Burwood, VICTORIA, Australia
  2. UNSW South Western Sydney Clinical School, Department of Neurology, Liverpool Hospital, University of New South Wales,, Liverpool, NSW, Australia
  3. Department of Medicine and Neurology, Melbourne Brain Centre at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  4. Department of Radiology at the Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia
  5. School of Public Health, , Monash University, Clayton, Victoria, Australia
  6. Ambulance Victoria, Doncaster, Victoria, Australia

Background: Tenecteplase is non-inferior to alteplase for thrombolysis of patients with acute ischemic stroke. The recent TASTE-A trial demonstrated that for patients treated on the Melbourne Mobile Stroke Unit (MSU), tenecteplase reduced perfusion lesion volumes (compared to alteplase) post-administration on imaging on admission to hospital, but the long-term cost-effectiveness of this approach needs further investigation.  

Aims: We seek to assess the cost-effectiveness of Tenecteplase compared to Alteplase in the MSU setting.

Methods: A within-trial (TASTE-A) economic analysis and a model-based long-term cost-effectiveness analysis were performed. This post-hoc within-trial economic analysis utilised the patient-level data (intention to treat, ITT) prospectively collected over the trial to calculate the difference in both healthcare costs and quality-adjusted life years (QALYs, estimated from 90-day modified Rankin scale score). A Markov microsimulation model was developed to simulate the long-term costs and benefits.

Results: In total, there were 104 patients with ischemic stroke randomised to tenecteplase (n=55) or alteplase (n=49) treatment groups. The ITT-based analysis showed that treatment with tenecteplase was associated with non-significantly lower costs [A$28,903 vs A$40,150 (p=0.056)] and greater benefits [0.171 vs 0.158 QALY (p=0.457)] than that for the alteplase group over the first 90 days post the index stroke. The long-term model showed that tenecteplase led to greater savings in costs (-A$18,610) and more health benefits (0.47 QALY or 0.31 LY gains). Tenecteplase-treated patients had reduced costs for rehospitalisation (-A$1,464), nursing home care (-A$16,767), and nonmedical care (-A$620) per patient.

Conclusion: Use of Tenecteplase in preference to Alteplase for pre-hospital thrombolysis in a MSU setting was cost-effective and improved long-term QALYs. The reduced total cost from Tenecteplase was driven by savings from acute hospitalisation and reduced need for nursing home care.