PMID- 36175016
OWN - NLM
STAT- MEDLINE
DCOM- 20231106
LR  - 20240301
IS  - 1759-8486 (Electronic)
IS  - 1759-8478 (Linking)
VI  - 15
IP  - e2
DP  - 2023 Nov
TI  - Cost-effectiveness of endovascular thrombectomy in acute stroke patients with 
      large ischemic core.
PG  - e166-e171
LID - 10.1136/jnis-2022-019460 [doi]
AB  - BACKGROUND: Evidence has shown that endovascular thrombectomy (EVT) treatment 
      improves clinical outcomes. Yet, its benefit remains uncertain in patients with 
      large established infarcts as defined by ASPECTS (Alberta Stroke Program Early CT 
      Score) <6. This study evaluates the cost-effectiveness of EVT, compared with 
      standard care (SC), in acute ischemic stroke (AIS) patients with ASPECTS 3-5. 
      METHODS: An economic evaluation study was performed combining a decision tree and 
      Markov model to estimate lifetime costs (2021 US$) and quality-adjusted life 
      years (QALYs) of AIS patients with ASPECTS 3-5. Incremental cost-effectiveness 
      ratios (ICERs), net monetary benefits (NMBs), and deterministic one-way and 
      two-way sensitivity analyses were performed. Probabilistic sensitivity analyses 
      were also performed to evaluate the robustness of our model. RESULTS: Compared 
      with SC, the cost-effectiveness analyses revealed that EVT yields higher lifetime 
      benefits (2.20 QALYs vs 1.41 QALYs) with higher lifetime healthcare cost per 
      patient ($285 861 vs $272 954). The difference in health benefits between EVT and 
      SC was 0.79 QALYs, equivalent to 288 additional days of healthy life per patient. 
      Even though EVT is more costly than SC alone, it is still cost-effective given 
      better outcomes with ICER of $16 239/QALY. The probabilistic sensitivity analyses 
      indicated that EVT was the most cost-effective strategy in 98.8% (9882 of 10 000) 
      of iterations at the willingness-to-pay threshold of $100 000 per QALY. 
      CONCLUSIONS: The results of this study suggest that EVT is cost-effective in AIS 
      patients with a large ischemic core (ASPECTS 3-5), compared with SC alone over 
      the patient's lifetime.
CI  - (c) Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and 
      permissions. Published by BMJ.
FAU - Sanmartin, Maria X
AU  - Sanmartin MX
AD  - Siemens Healthineers USA, Malvern, Pennsylvania, USA 
      maria.sanmartin@siemens-healthineers.com.
AD  - Imaging Clinical Effectiveness and Outcomes Research, Center for Health 
      Innovations and Outcomes Research, Feinstein Institute for Medical Research, 
      Manhasset, New York, USA.
FAU - Katz, Jeffrey M
AU  - Katz JM
AD  - Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at 
      Hofstra/Northwell, Manhasset, New York, USA.
AD  - Department of Radiology, Donald and Barbara Zucker School of Medicine at 
      Hofstra/Northwell, Manhasset, New York, USA.
FAU - Wang, Jason
AU  - Wang J
AD  - Department of Radiology, Donald and Barbara Zucker School of Medicine at 
      Hofstra/Northwell, Manhasset, New York, USA.
FAU - Malhotra, Ajay
AU  - Malhotra A
AUID- ORCID: 0000-0001-9223-6640
AD  - Department of Radiology and Biomedical Imaging, Yale University School of 
      Medicine, New Haven, Connecticut, USA.
FAU - Sangha, Kinpritma
AU  - Sangha K
AD  - Siemens Healthineers USA, Malvern, Pennsylvania, USA.
AD  - Imaging Clinical Effectiveness and Outcomes Research, Center for Health 
      Innovations and Outcomes Research, Feinstein Institute for Medical Research, 
      Manhasset, New York, USA.
FAU - Bastani, Mehrad
AU  - Bastani M
AUID- ORCID: 0000-0001-9571-9488
AD  - Imaging Clinical Effectiveness and Outcomes Research, Center for Health 
      Innovations and Outcomes Research, Feinstein Institute for Medical Research, 
      Manhasset, New York, USA.
FAU - Martinez, Gabriela
AU  - Martinez G
AD  - Imaging Clinical Effectiveness and Outcomes Research, Center for Health 
      Innovations and Outcomes Research, Feinstein Institute for Medical Research, 
      Manhasset, New York, USA.
FAU - Sanelli, Pina C
AU  - Sanelli PC
AD  - Imaging Clinical Effectiveness and Outcomes Research, Center for Health 
      Innovations and Outcomes Research, Feinstein Institute for Medical Research, 
      Manhasset, New York, USA.
AD  - Department of Radiology, Donald and Barbara Zucker School of Medicine at 
      Hofstra/Northwell, Manhasset, New York, USA.
LA  - eng
GR  - R56 NS114275/NS/NINDS NIH HHS/United States
PT  - Journal Article
DEP - 20220929
PL  - England
TA  - J Neurointerv Surg
JT  - Journal of neurointerventional surgery
JID - 101517079
SB  - IM
MH  - Humans
MH  - *Ischemic Stroke
MH  - Cost-Benefit Analysis
MH  - *Stroke/diagnostic imaging/surgery
MH  - Thrombectomy
MH  - Cost-Effectiveness Analysis
OTO - NOTNLM
OT  - economics
OT  - stroke
OT  - thrombectomy
COIS- Competing interests: MXS and KS hold a Visiting Scholar appointment at the 
      Feinstein Institutes for Medical Research in the Center for Health Innovations 
      and Outcomes Research and are employees of Siemens Medical Solutions USA Inc. MXS 
      and KS are shareholders of Siemens Healthineers. JMK, JW and PCS receive research 
      support from Siemens Healthineers.
EDAT- 2022/09/30 06:00
MHDA- 2023/11/06 06:43
CRDT- 2022/09/29 20:42
PHST- 2022/08/01 00:00 [received]
PHST- 2022/09/14 00:00 [accepted]
PHST- 2023/11/06 06:43 [medline]
PHST- 2022/09/30 06:00 [pubmed]
PHST- 2022/09/29 20:42 [entrez]
AID - jnis-2022-019460 [pii]
AID - 10.1136/jnis-2022-019460 [doi]
PST - ppublish
SO  - J Neurointerv Surg. 2023 Nov;15(e2):e166-e171. doi: 10.1136/jnis-2022-019460. 
      Epub 2022 Sep 29.