Journal article
Cost‐Effectiveness of Endovascular Thrombectomy in Patients with Large Ischemic Stroke
Annals of neurology, Vol.97(2), pp.222-231
02/2025
DOI: 10.1002/ana.27119
PMID: 39479933
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
Details
- Title: Subtitle
- Cost‐Effectiveness of Endovascular Thrombectomy in Patients with Large Ischemic Stroke
- Creators
- Lan Gao - Deakin UniversityLeonid Churilov - The Royal Melbourne HospitalHannah Johns - The Royal Melbourne HospitalDeep Pujara - University Hospitals of ClevelandAmeer E. Hassan - Valley Baptist Medical CenterMichael Abraham - University of Kansas Medical CenterSantiago Ortega-Gutierrez - University of IowaMuhammad Shazam Hussain - Cleveland ClinicMichael Chen - Rush University Medical CenterSpiros Blackburn - The University of Texas Health Science Center at HoustonClark W. Sitton - The University of Texas Health Science Center at HoustonFlorentina M. E. Pinckaers - Maastricht University Medical CentreWim H. van Zwam - Maastricht University Medical CentreGeorgios Tsivgoulis - National and Kapodistrian University of AthensMichael D. Hill - University of CalgaryJames C. Grotta - Memorial HermannScott Kasner - University of PennsylvaniaMarc Ribo - Vall d'Hebron Hospital UniversitariBruce C Campbell - The Royal Melbourne HospitalAmrou Sarraj - University Hospitals of ClevelandSELECT2 investigators
- Resource Type
- Journal article
- Publication Details
- Annals of neurology, Vol.97(2), pp.222-231
- DOI
- 10.1002/ana.27119
- PMID
- 39479933
- NLM abbreviation
- Ann Neurol
- ISSN
- 0364-5134
- eISSN
- 1531-8249
- Publisher
- WILEY
- Language
- English
- Electronic publication date
- 10/31/2024
- Date published
- 02/2025
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984743396902771
Metrics
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