Table 3

Major limitations listed in the cost-effectiveness studies of rtPA for acute ischaemic stroke

Study/year/countryLimitations
Yan et al 33/2015/China

  • The medical costs did not include the cost after discharge

  • The study used charges not real costs

  • The study used data from a single hospital in China

Boudreau et al 24/2014/USA

  • The results were specific to the assumptions and the data used

  • QALYs were derived by using multiple inconsistent studies

  • Long-term cost, QALYs, disabilities and mortality data were limited and dated

Pan et al 34/2014/China

  • Inaccurate estimate for each component of rtPA-associated cost

  • Informal caregiving costs were not included

  • The study did not model changes in functional status from causes other than stroke

  • The study used the efficacy and the utility data from studies in high-income countries

Boudreau et al 25/2013/USA

  • The results are specific to the assumptions and the data used

  • The data are from numerous published studies including clinical trials

Kazley et al 26/2013/USA (SC)

  • The study examined only a single state

  • The assumptions and data used in the study did not fully represent the clinical practise situation

  • Data do not represent the current year

  • The study may underestimate the benefit because of previously validated model with conservative estimates

  • The study only considered treatment within 3 hours after stroke onset (not up to 4.5 hours)

Tan Tanny et al 31/2013/Australia

  • The study assumed that survival and quality of life would not change between 90 days and 12 months after stroke

  • Efficacy data were drawn from analyses of studies of rtPA being given between 3 and 4.5 hours (not rtPA within 4.5 hours)

Tung et al 27/2011/USA

  • Input parameters were best estimates from previously published data

  • The study did not model changes in functional status from causes other than stroke

Johnston28/2010/USA

  • The results depended on a single cost-utility analysis that required a number of uncertain assumptions

Ehlers et al 37/2007/Denmark

  • The lack of adequate long-term data

Mar et al 38/2005/Spain

  • The use of proxies to answer the questionnaire

Chambers et al 30/2002/UK

  • Limited published data about the cost of care for stroke survivors

  • Indirect costs, informal care costs and quality of life of other family members were excluded from the model

  • No sufficient published information on resource use, rates of recurrence or disability and mortality by age group

  • The variability of parameter estimates is not well known

Sinclair et al 35/2001/Canada

  • Short-term hospitalisation cost based on a small sample size of 22 patients from a single centre (generalisability)

  • There was a difficulty in determining the costs of stroke care and services in Canada on a ‘per patient basis’

  • The study used a point estimate without a formal quantitative estimate of its precision

Fagan et al 9/1998/USA

  • The study used a placebo group from the NINDS rtPA Stroke Trial as the source of data for some aspects of the cost analysis

  • The protocol precluded antithrombotic therapy in the first 24 hours after stroke onset, which may affect cost and health outcomes

  • Three studies (Te Ao et al 36 Moodie et al 32 Sandercock et al 29) did not list limitations.

  • NINDS, National Institue of Neurologic Disorders and Stroke; rtPA, intravenous recombinant tissue plasminogen activator; QALY, quality-adjusted life year.