Cost-Effectiveness of Endovascular Thrombectomy in Patients with Large Ischemic Stroke.

IF 8.1 1区 医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2024-10-31 DOI:10.1002/ana.27119
Lan Gao, Leonid Churilov, Hannah Johns, Deep Pujara, Ameer E Hassan, Michael Abraham, Santiago Ortega-Gutierrez, Muhammad Shazam Hussain, Michael Chen, Spiros Blackburn, Clark W Sitton, Florentina M E Pinckaers, Wim H van Zwam, Georgios Tsivgoulis, Michael D Hill, James C Grotta, Scott Kasner, Marc Ribo, Bruce C Campbell, Amrou Sarraj
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Abstract

Objectives: Whereas highly cost-effective and cost-saving for patients with small infarcts, whether endovascular thrombectomy (EVT) remains cost-effective in patients with extensive ischemic injury is uncertain.

Methods: We conducted a model-based cost-effectiveness analysis from the United States, Australian, and Spanish societal perspectives, using a 7-state Markov model, with each state defined by the modified Rankin Scale (mRS) score. Initial probabilities at 3 months were derived from the SELECT2 trial. All other model inputs, including transition probabilities, health care and non-health care costs, and utility weights, were sourced from published literature and government websites. Our analysis included extensive sensitivity and subgroup analyses.

Results: EVT in patients with large ischemic stroke improved health outcomes and was associated with lower costs from a societal viewpoint. EVT was cost-effective with a mean between-group difference of 1.24 quality-adjusted life years (QALYs), and a cost-saving of $23,409 in the United States, $10,691 in Australia, and $30,036 in Spain, in addition to uncosted benefits in productivity for patients and carers. Subgroup analyses were directionally consistent with the overall population, notably with preserved cost-effectiveness in older patients (≥ 70 years) and those with more severe strokes (National Institutes of Health Stroke Scale [NIHSS] ≥ 20). Sensitivity analyses were largely consistent with the base-case results.

Interpretation: EVT demonstrated cost-effectiveness in patients with large core across different settings in the United States, Australia, and Spain, including older patients and those with more severe strokes. These results further support adaptation of systems of care to accommodate the expansion of thrombectomy eligibility to patients with large cores and maximize EVT benefits. ANN NEUROL 2024.

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大面积缺血性脑卒中患者血管内血栓切除术的成本效益。
目的:虽然血管内血栓切除术(EVT)对小面积梗死患者具有很高的成本效益和节约成本的作用,但对大面积缺血性损伤患者是否仍然具有成本效益还不确定:虽然血管内血栓切除术(EVT)对小面积梗死患者具有很高的成本效益并能节约成本,但对大面积缺血性损伤患者是否仍具有成本效益尚不确定:我们从美国、澳大利亚和西班牙的社会角度出发,使用 7 状态马尔可夫模型进行了基于模型的成本效益分析,每个状态由修正的 Rankin 量表(mRS)评分定义。3 个月时的初始概率来自 SELECT2 试验。所有其他模型输入,包括过渡概率、医疗和非医疗成本以及效用权重,均来自已发表的文献和政府网站。我们的分析包括大量的敏感性分析和亚组分析:结果:对大面积缺血性脑卒中患者进行 EVT 可改善健康预后,从社会角度看成本更低。EVT具有成本效益,组间平均差异为1.24质量调整生命年(QALYs),在美国节省成本23,409美元,在澳大利亚节省成本10,691美元,在西班牙节省成本30,036美元。亚组分析的方向与总体人群一致,尤其是老年患者(≥ 70 岁)和脑卒中较严重的患者(美国国立卫生研究院脑卒中量表 [NIHSS] ≥ 20)的成本效益保持不变。敏感性分析结果与基础病例结果基本一致:EVT在美国、澳大利亚和西班牙不同环境下的大核心患者中显示出成本效益,包括年龄较大的患者和脑卒中较严重的患者。这些结果进一步支持对医疗系统进行调整,以适应将血栓切除术的适用范围扩大到大核心患者,并最大限度地提高 EVT 的效益。ann neurol 2024。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Neurology
Annals of Neurology 医学-临床神经学
CiteScore
18.00
自引率
1.80%
发文量
270
审稿时长
3-8 weeks
期刊介绍: Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.
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