Cost-Effectiveness of CT Perfusion for Selecting Patients for Intravenous Thrombolysis: A US Hospital Perspective

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Fig 1.
One-way sensitivity analysis: effect of parameter variation on the incremental cost per QALY for patient selection using penumbra-based CTP compared with CT. Dark-shaded bars represent the upper bound. Striped bars represent the lower bound. Baseline incremental cost / QALY = −$184,082.
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Fig 2.
Results of probabilistic sensitivity analysis: incremental cost-effectiveness scatterplot of patient selection using CTP versus CT for 90 days following primary stroke. Dotted line represents an incremental cost / QALY = $50,000. Points to right of the dotted the line are considered cost-effective. Gray dots represent simulations. The black dot represents the base-case result.

Table 1:

Costs and outcomes associated with selecting patients for IV tPA treatment with CTP versus CT scanning base-case results

Outcome (per patient)	Usual Care	CTP
% of patients with ischemic stroke treated	28.30%	20.94%
% of all patients with stroke treated	24.62%	18.22%
% of all patients with stroke who receive CTP	0.00%	49.42%
Favorable outcome (mRS, 0.1)	39.44%	40.03%
mRS outcomes for patients with ischemic stroke
% with 90-day mRS 0	18.41%	18.23%
% with 90-day mRS 1	21.03%	21.80%
% with 90-day mRS 2	12.56%	11.96%
% with 90-day mRS 3	13.14%	13.27%
% with 90-day mRS 4	15.75%	16.13%
% with 90-day mRS 5	7.13%	6.78%
% dead at 90 days	11.98%	11.83%
Life-years	0.2115	0.2119
QALYs	0.1241	0.1246
Hospitalization costs (including SICH) (in US $)	$11,400	$11,358
Novel diagnostic costs (in US $)	$0	$236
Drug costs (in US $)	$1,070	$792
Total costs (in US $)	$12,470	$12,386
Incremental cost per life-year gained (in US $)	–	Cost-saving
Incremental cost per QALY gained (in US $)	–	Cost-saving
Incremental cost per major disability avoided (mRS, ≥3) (in US $)		Cost-saving