Cost-effectiveness of tirofiban for acute ischemic stroke without large or medium-sized vessel occlusion: A Markov modelling analysis from the Chinese and United States perspectives

作者全名："Wang, Li; Zeng, Yuhong; Zhou, Limei; Xu, Ping; Guo, Xianbin; Xie, Yu; Cai, Junxiu; Pan, Min; Tang, Jie; Gong, Qingtao; Su, Rong; Liu, Yan; Lou, Yake"

作者地址："[Wang, Li; Zhou, Limei; Xu, Ping; Guo, Xianbin; Xie, Yu; Cai, Junxiu; Pan, Min; Tang, Jie; Gong, Qingtao; Su, Rong; Liu, Yan] Zigong Third Peoples Hosp, Dept Neurol, Zigong, Peoples R China; [Zeng, Yuhong] Army Med Univ, Third Mil Med Univ, Coll Prevent Med, Dept Epidemiol, Chongqing, Peoples R China; [Zeng, Yuhong] Army Med Univ, Third Mil Med Univ, Evidence based Med & Clin Epidemiol Ctr, Chongqing, Peoples R China; [Lou, Yake] Chongqing Med Univ, Affiliated Hosp 2, Dept Cardiol, Chongqing, Peoples R China"

通信作者："Lou, YK (通讯作者)，Chongqing Med Univ, Affiliated Hosp 2, Dept Cardiol, Chongqing, Peoples R China."

来源：PLOS ONE

ESI学科分类：Multidisciplinary

WOS号：WOS:001164078000033

JCR分区：Q1

影响因子：2.9

年份：2024

卷号：19

期号：2

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结束页：　

文献类型：Article

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摘要："Background The RESCUE BT2 trial recently showcased the efficacy of tirofiban in treating acute ischemic stroke (AIS) without large or medium-sized vessel occlusion. To further assess the value of tirofiban from the perspectives of Chinese and US healthcare system, a study was conducted to evaluate its cost-effectiveness.Methods A hybrid model, integrating a short-term decision tree with a long-term Markov model, was developed to assess cost-effectiveness between tirofiban and aspirin for stroke patients without large or medium-sized vessel occlusion. Efficacy data for tirofiban was sourced from the RESCUE BT2 trial, while cost information was derived from published papers. Outcomes measured included respective cost, effectiveness, and incremental cost-effectiveness ratio (ICER). We conducted a one-way sensitivity analysis to assess the robustness of the results. Additionally, we performed probabilistic sensitivity analysis (PSA) through 10,000 Monte Carlo simulations to evaluate the uncertainties associated with the results.Results The study revealed that tirofiban treatment in AIS patients without large or medium-sized vessel occlusion led to a considerable reduction of 2141 Chinese Yuan (CNY) in total cost, along with a lifetime gain of 0.14 quality-adjusted life years (QALYs). In the US settings, tirofiban also exhibited a lower cost ($197,055 versus $201,984) and higher effectiveness (4.15 QALYs versus 4.06 QALYs) compared to aspirin. One-way sensitivity analysis revealed that post-stroke care costs and stroke utility had the greatest impact on ICER fluctuation in both Chinese and US settings. However, these variations did not exceed the willingness-to-pay threshold. PSA demonstrated tirofiban's superior acceptability over aspirin in over 95% of potential scenarios.Conclusion Tirofiban treatment for AIS without large or medium-sized vessel occlusion appeared dominant compared to aspirin in both China and the US."

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