In-Hospital Cost-Consequence Analysis of Systemic Alteplase Versus Unfractionated Heparin in Intermediate-High-Risk Pulmonary Embolism

This repository contains the R analysis code and model output files supporting the manuscript: "In-Hospital Cost-Consequence Analysis of Systemic Alteplase Versus Unfractionated Heparin in Intermediate-High-Risk Pulmonary Embolism" (Marić et al., 2026).The R script (pe_alteplase_vs_ufh_cost_model.R) implements a patient-level, hospital-perspective cost-consequence model comparing systemic alteplase (100 mg IV) with unfractionated heparin (UFH) in 80 ICU-admitted adults with CT-confirmed intermediate-high-risk pulmonary embolism prospectively enrolled at Clinical Hospital Sveti Duh, Zagreb, Croatia (2020–2024). Length of stay was modelled using negative binomial regression with marginal standardisation (G-computation) to adjust for confounding by indication. Incremental in-hospital costs were estimated from institutional tariff data (2026 EUR), and uncertainty was quantified using 2,000 stratified bootstrap iterations. The script further implements break-even threshold analysis, a two-dimensional ICU tariff × drug price scenario grid, and pre-specified sensitivity analyses covering bleeding cost scenarios and UFH cost-basis assumptions.Output files include base-case cost results, bootstrap summary statistics, sensitivity and scenario analysis tables, break-even analysis data, and budget impact estimates. All analyses were conducted in R version 4.5.0. Inline code comments were added with assistance from Claude Sonnet 4.6 (Anthropic).