The effects of intravenous oxpentifylline on blood viscosity and cerebral blood flow were studied in eight patients with cerebrovascular disease using a double‐blind placebo controlled design. A single dose of 200 mg oxpentifylline in 10 ml saline was given by intravenous injection over 10 min and compared with 10 ml saline alone. Whole blood and plasma viscosity were measured in a Contraves LS 30 coaxial viscometer at shear rates of 0.7 and 94.5 s‐1. Cerebral blood flow was measured by the non‐invasive intravenous xenon133 clearance method. The measurements were made before and then 30 min after the start of the injection of drug or saline alone. Oxpentifylline was found to have no significant effect on blood viscosity or cerebral blood flow.
We undertook a cost-effectiveness analysis alongside the Pragmatic Ischaemic Stroke Thrombectomy Evaluation (PISTE) trial. In addition, a decision-analytic model was developed to estimate the long-term cost-effectiveness of thrombectomy using all available trial evidence. Meta-analysis was used to estimate the clinical effectiveness; resource use and costs were sourced from the PISTE study and the broader literature. Value of implementation analysis was used to estimate the potential value of implementing this treatment into routine clinical practice within the UK NHS. As health budget responsibility is devolved within the UK, we plan to estimate the five-year budget impact of introducing mechanical thrombectomy into routine practice within the devolved NHS in Scotland. Results: Compared with standard treatment, thrombectomy was not shown to be cost-effective within-trial/90-day period. However, the reverse was observed with the long-term model (ICER £3,857 per QALY gained). We estimate that 42,525 patients are potentially eligible to receive this treatment in the UK over a five year period. The net monetary benefit (health benefit in monetary terms) is £13,704 per patient. Assuming a five-year time horizon and full implementation, the value of implementation was £542 million. We estimate the "break-even" value of implementation activity point at approximately 26% implementation. cOnclusiOns: Based on a lifetime horizon, mechanical thrombectomy is cost-effective compared with standard care. If implementation is greater than 26%, the value of implementation is greater than the cost of implementation.
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