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]
日期:2023-01-01
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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