Budgetary impact analysis of alteplase - recombinant tissue plasminogen activator (rtPA) - as a thrombolytic treatment for acute ischemic stroke in Colombia

Thrombolysis is effective for treating acute ischemic stroke (AIS). Trials have evaluated its effectiveness at different timepoints after stroke. The objective of the study was to evaluate the clinical and budgetary impact of increasing the proportion of thrombolyzed acute ischemic stroke patients in Colombia. 

The budgetary impact was estimated for a 5-year time horizon from the perspective of the third-party payer. Costs were estimated using local standardized methods and expressed in US dollars of 2020. We compared two scenarios: a current one and an alternative one, with doubled thrombolysis access

The increase in thrombolyzed patients would decrease the number of patients with sequelae by 1,721, 2,594 and 1,007 in the ranges of 0–90 minutes, 91–180 and 181–270, respectively. The budget effort increase for each of the treatment initiation ranges is of USD$15,525,649(+5.5%), USD$16,665,304(+5.7%) and USD$16,963,231(+7.0%), respectively. 

Doubling the number of patients with AIS who are thrombolyzed would lead to reductions in the number of patients with sequelae and would require a budgetary effort of 5.5–7.0%. The early initiation of treatment gives an additional benefit in reducing the number of sequelae and a lower budgetary impact than initiation within the later time window.