Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients.

Abstract

Abstract Objectives Stroke treatment with intravenous tissue-type plasminogen activator (tPA) is efective and efcient, but as its benefts are highly time dependent, it is essential to treat the patient promptly after symptom onset. This study evaluates the cost-efectiveness of a blood biomarker test to diferentiate ischemic and hemorrhagic stroke to guide pre-hospital treatment with tPA in patients with suspected stroke, compared with standard hospital management. The standard care for patients sufering stroke consists mainly in diagnosis, treatment, hospitalization and monitoring. Methods A Markov model was built with four health states according to the modifed Rankin scale, in adult patients with suspected moderate to severe stroke (NIHSS 4-22) within 4.5 hours after symptom onset. A Spanish Health System perspective was used. The time horizon was 15 years. Quality-adjusted life-years (QALYs) and life-years gained (LYGs) were used as a measure of efectiveness. Short- and long-term direct health costs were included. Costs were expressed in Euros (2022). A discount rate of 3% was used. Probabilistic sensitivity analysis and several one-way sensitivity analyses were conducted. Results The use of a blood-test biomarker compared with standard care was associated with more QALYs (4.87 vs. 4.77), more LYGs (7.18 vs. 7.07), and greater costs (12,807¿ vs. 12,713¿). The ICER was 881¿/QALY. Probabilistic sensitivity analysis showed that the biomarker test was cost-efective in 82% of iterations using a threshold of 24,000¿/QALY. Conclusions The use of a blood biomarker test to guide pre-hospital thrombolysis is cost-efective compared with standard hospital care in patients with ischemic stroke.