Cost-effectiveness of tenecteplase versus alteplase for acute ischemic stroke

Introduction: Alteplase is widely used as an intravenous thrombolytic drug in acute ischemic stroke (AIS). Recently however, tenecteplase, a modified form of tissue plasminogen activator, has been shown to increase early recanalization rate and proven be non-inferior with similar safety profile compared alteplase. This study aims evaluate the cost-effectiveness 0.25 mg/kg tenecteplase versus 0.9 alteplase for thrombolysis AIS patients from Dutch healthcare payer perspective. Methods: A Markov decision-analytic model was constructed assess total costs, quality-adjusted life year (QALY), incremental ratio, net monetary benefit (INMB) two treatments at willingness-to-pay (WTP) thresholds €50,000/QALY €80,000/QALY over 10-year time horizon. One-way sensitivity analysis, probabilistic scenario analysis were conducted test robustness results. Clinical data obtained large randomized controlled trials real-world data. Results: Treatment saved €21 per patient while gaining 0.05 QALYs, resulting INMB €2381, clearly rendering cost-effective Importantly, remained alternative all scenarios, including due vessel occlusion (LVO). Probabilistic proved 71.0% probability WTP threshold €50,000/QALY. Conclusions: Tenecteplase treatment (including LVO) The finding supports broader use care, health outcomes improve acceptable costs having practical advantages, profile.