PharmacoEconomics & Outcomes News 496 - 11 Feb 2006

24-Hour hospitalisation after TIAmay be worthwhile

US-based researchers report that hospitalisingpatients diagnosed with transient ischaemic attack (TIA)for 24 hours is"borderline" cost effective, due to thebenefits associated with early administration of alteplase[tissue plasminogen activator; tPA] in the event of astroke.

They modelled previously published data, includingdata from a cost-effectiveness study, to estimate thecosts and outcomes associated with hospitalisingpatients with an emergency room diagnosis of TIA for24 hours.

The model estimated that 2.2% of hospitalisedpatients would receive alteplase compared with 0.3% ofpatients not admitted. Hospitalised patients gained0.0107 quality-adjusted life-years (QALYs), but theyincurred additional costs of $US588 per patient,compared with those who were not admitted.* In thebase-case scenario, 24-hour hospitalisation wasassociated with a cost-effectiveness ratio of $55 044/QALY gained. However, variation to model assumptionsin a sensitivity analysis predicted a more favourablecost-effectiveness ratio (< $US50 000/QALY gained)when: the ‘hotel costs’ of hospitalisation were≤ $US640; the 24-hour risk of stroke was ≥ 5%; theQALYs gained were > 0.60; alteplase was administeredfor stroke in ≥ 58% of patients; or the alteplase-relatedsavings per patient were > $US8000.* Costs (2003 values) were reported from a societal perspective andincluded those related to: ‘hotel costs’ of 24-hour hospitalisation,alteplase, and stroke events, namely, hospitalisations, rehabilitation,and nursing home care. Costs were discounted by 5% per annum.

Nguyen-Huynh MN, et al. Is hospitalization after TIA cost-effective on the basis oftreatment with tPA? Neurology 65: 1799-1801, No. 11, 13 Dec 2005 801031644

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PharmacoEconomics & Outcomes News 11 Feb 2006 No. 4961173-5503/10/0496-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved