Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration

医学 生活质量(医疗保健) 冲程(发动机) 随机对照试验 质量调整寿命年 改良兰金量表 物理疗法 成本效益 急诊医学 外科 内科学 缺血性中风 护理部 缺血 工程类 风险分析(工程) 机械工程
作者
Johanna M. Ospel,Wolfgang G. Kunz,Rosalie McDonough,Wim H van Zwam,Florentina M.E. Pinckaers,Jeffrey L. Saver,Michael D. Hill,Andrew M. Demchuk,Tudor G Jovin,Peter Mitchell,Bruce C.V. Campbell,Phil White,Keith W. Muir,Hamza Achit,Serge Bracard,Scott Brown,Mayank Goyal
出处
期刊:Stroke [Lippincott Williams & Wilkins]
卷期号:54 (1): 226-233 被引量:2
标识
DOI:10.1161/strokeaha.121.038407
摘要

The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2.Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed.EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only.From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.
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