Cost-effectiveness of endovascular treatment after 6-24 h in ischaemic stroke patients with collateral flow on CT-angiography: A model-based economic evaluation of the MR CLEAN-LATE trial.
Eur Stroke J
; 9(2): 348-355, 2024 Jun.
Article
em En
| MEDLINE
| ID: mdl-38153049
ABSTRACT
BACKGROUND:
The MR CLEAN-LATE trial has shown that patient selection for endovascular treatment (EVT) in the late window (6-24 h after onset or last-seen-well) based on the presence of collateral flow on CT-angiography is safe and effective. We aimed to assess the cost-effectiveness of late-window collateral-based EVT-selection compared to best medical management (BMM) over a lifetime horizon (until 95 years of age). MATERIALS ANDMETHODS:
A model-based economic evaluation was performed from a societal perspective in The Netherlands. A decision tree was combined with a state-transition (Markov) model. Health states were defined by the modified Rankin Scale (mRS). Initial probabilities at 3-months post-stroke were based on MR CLEAN-LATE data. Transition probabilities were derived from previous literature. Information on short- and long-term resource use and utilities was obtained from a study using MR CLEAN-LATE and cross-sectional data. All costs are expressed in 2022 euros. Costs and quality-adjusted life years (QALYs) were discounted at a rate of 4% and 1.5%, respectively. The effect of parameter uncertainty was assessed using probabilistic sensitivity analysis (PSA).RESULTS:
On average, the EVT strategy cost 159,592 (95% CI 140,830-180,154) and generated 3.46 QALYs (95% CI 3.04-3.90) per patient, whereas the costs and QALYs associated with BMM were 149,935 (95% CI 130,841-171,776) and 2.88 (95% CI 2.48-3.29), respectively. The incremental cost-effectiveness ratio per QALY and the incremental net monetary benefit were 16,442 and 19,710, respectively. At a cost-effectiveness threshold of 50,000/QALY, EVT was cost-effective in 87% of replications. DISCUSSION ANDCONCLUSION:
Collateral-based selection for late-window EVT is likely cost-effective from a societal perspective in The Netherlands.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Análise Custo-Benefício
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Anos de Vida Ajustados por Qualidade de Vida
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Procedimentos Endovasculares
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Angiografia por Tomografia Computadorizada
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AVC Isquêmico
Limite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
País/Região como assunto:
Europa
Idioma:
En
Revista:
Eur Stroke J
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Holanda