A Prospective Economic Evaluation of Rapid Endovascular Therapy for Acute Ischemic Stroke

Sevick, Laura; Demchuk, Andrew M.; Shuaib, Ashfaq; Smith, Eric E.; Rempel, Jeremy; Butcher, Kenneth; Menon, Bijoy K; Jeerakathil, Thomas; Thornton, John; Williams, David J.; Poppe, Alexandre Y; Roy, Daniel; Goyal, Mayank; Hill, Michael D; Clement, Fiona; Trialists, Escape

doi:10.1017/cjn.2021.4

Cited by 3 publications

(4 citation statements)

References 29 publications

(42 reference statements)

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“…The finding that EVT is cost-saving is internationally consistent. In Canada, Sevick et al reported that EVT is cost-effective if the time-horizon is 1 year or more, 22 and Xie et al reported a similar benefit using a cost-utility analysis. 23 In the US, by comparing the cost of EVT with the average reimbursement from insurance, Brinjikji et al concluded that the improved patient outcomes associated with EVT may result in decreases in long-term costs.…”

Section: Discussionmentioning

confidence: 99%

Return on Investment in Endovascular Care: The Case of Endovascular Reperfusion Alberta

Thanh

Jeerakathil

Stang

et al. 2021

Can. J. Neurol. Sci.

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Objective: We examined the return on investment (ROI) from the Endovascular Reperfusion Alberta (ERA) project, a provincially funded population-wide strategy to improve access to endovascular therapy (EVT), to inform policy regarding sustainability. Methods: We calculated net benefit (NB) as benefit minus cost and ROI as benefit divided by cost. Patients treated with EVT and their controls were identified from the ESCAPE trial. Using the provincial administrative databases, their health services utilization (HSU), including inpatient, outpatient, physician, long-term care services, and prescription drugs, were compared. This benefit was then extrapolated to the number of patients receiving EVT increased in 2018 and 2019 by the ERA implementation. We used three time horizons, including short (90 days), medium (1 year), and long-term (5 years). Results: EVT was associated with a reduced gross HSU cost for all the three time horizons. Given the total costs of ERA were $2.04 million in 2018 ($11,860/patient) and $3.73 million in 2019 ($17,070/patient), NB per patient in 2018 (2019) was estimated at −$7,313 (−$12,524), $54,592 ($49,381), and $47,070 ($41,859) for short, medium, and long-term time horizons, respectively. Total NB for the province in 2018 (2019) were −$1.26 (−$2.74), $9.40 ($10.78), and $8.11 ($9.14) million; ROI ratios were 0.4 (0.3), 5.6 (3.9) and 5.0 (3.5). Probabilities of ERA being cost saving were 39% (31%), 97% (96%), and 94% (91%), for short, medium, and long-term time horizons, respectively. Conclusion: The ERA program was cost saving in the medium and long-term time horizons. Results emphasized the importance of considering a broad range of HSU and long-term impact to capture the full ROI.

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Section: Discussionmentioning

confidence: 99%

Return on Investment in Endovascular Care: The Case of Endovascular Reperfusion Alberta

Thanh

Jeerakathil

Stang

et al. 2021

Can. J. Neurol. Sci.

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“…Model parameters related to efficacy of treatment at 90 days after stroke, [9][10][11][12][13][14][15] health utilities [24][25][26] and costs of care 18,[27][28][29][30][31][32][33][34][35] are summarized in Appendix 1, Supplementary Table S1 at www.cmajopen.ca/content/11/3/E443/suppl/DC1). The descriptions, sources and assumptions for the parameters are also provided in Appendix 1.…”

Section: Model Parametersmentioning

confidence: 99%

Cost-effectiveness of endovascular thrombectomy with alteplase versus endovascular thrombectomy alone for acute ischemic stroke secondary to large vessel occlusion

Ye,

Zhou,

Zhang

et al. 2023

cmajo

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Background: Recent randomized trials have suggested that endovascular thrombectomy (EVT) alone may provide similar functional outcomes as the current standard of care, EVT combined with intravenous alteplase treatment, for acute ischemic stroke secondary to large vessel occlusion. We conducted an economic evaluation of these 2 therapeutic options. Methods: We constructed a decision analytic model with a hypothetical cohort of 1000 patients to assess the cost-effectiveness of EVT with intravenous alteplase treatment versus EVT alone for acute ischemic stroke secondary to large vessel occlusion from both the societal and public health care payer perspectives. We used studies and data published in 2009–2021 for model inputs, and acquired cost data for Canada and China, representing high- and middle-income countries, respectively. We calculated incremental cost-effectiveness ratios (ICERs) using a lifetime horizon and accounted for uncertainty using 1-way and probabilistic sensitivity analyses. All costs are reported in 2021 Canadian dollars. Results: In Canada, the difference in quality-adjusted life-years (QALYs) gained between EVT with alteplase and EVT alone was 0.10 from both the societal and health care payer perspectives. The difference in cost was $2847 from a societal perspective and $2767 from the payer perspective. In China, the difference in QALYs gained was 0.07 from both perspectives, and the difference in cost was $1550 from the societal perspective and $1607 from the payer perspective. One-way sensitivity analyses showed that the distributions of modified Rankin Scale scores at 90 days after stroke were the most influential factor on ICERs. For Canada, compared to EVT alone, the probability that EVT with alteplase would be cost-effective at a willingness-to-pay threshold of $50 000 per QALY gained was 58.7% from a societal perspective and 58.4% from a payer perspective. The corresponding values for at a willingness-to-pay threshold of $47 185 (3 times the Chinese gross domestic product per capita in 2021) were 65.2% and 67.4%. Interpretation: For patients with acute ischemic stroke due to large vessel occlusion eligible for immediate treatment with both EVT alone and EVT with intravenous alteplase treatment, it is uncertain whether EVT with alteplase is cost-effective compared to EVT alone in Canada and China.

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“…Incomplete formalized reimbursement services for the mechanical thrombectomy (related to the lack of dedicated procedures) are also a real problem, which, in the case of randomized trials, show that the use of EVT as an option for the treatment of acute ischemic stroke eliminates the costs associated with patient care during the first year of stroke and generates savings in the next years of the patient’s life [ 47 , 48 ]. In the case of staffing problems and the growing number of stroke patients due to the aging society, the solution could be employment standards analogous to those in intensive care units: 1:1 or 1:2.…”

Section: Qualification For the Causal Treatment Of Ischemic Strokementioning

confidence: 99%

“…A particular interesting field about acute stroke management is related to neuroprotective therapies. Some reports suggest a potential role of these therapies [ 137 ], although underlying mechanisms are still unknown and evidence of their usefulness in clinical setting is lacking [ 47 ]. An example of endogenous neuroprotection of damaged neurons after a stroke stimulating the remodeling of the mitochondrial network architecture are the steps of gradual cooling down to 33 °C, which facilitates the transfer of mitochondria from astrocytes to damaged neurons and endothelial cells, while increasing the content of intracellular ATP, mitochondrial membrane potential (MMP), and cell viability during hypoxia [ 138 , 139 ].…”

Section: Examples Of Neuroprotection In the Treatment Of Ischemic Strokementioning

confidence: 99%

The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches

Popiela

Krzyściak

Pilato

et al. 2022

JCM

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Ischemic stroke accounts for over 80% of all strokes and is one of the leading causes of mortality and permanent disability worldwide. Intravenous administration of recombinant tissue plasminogen activator (rt-PA) is an approved treatment strategy for acute ischemic stroke of large arteries within 4.5 h of onset, and mechanical thrombectomy can be used for large arteries occlusion up to 24 h after onset. Improving diagnostic work up for acute treatment, reducing onset-to-needle time and urgent radiological access angiographic CT images (angioCT) and Magnetic Resonance Imaging (MRI) are real problems for many healthcare systems, which limits the number of patients with good prognosis in real world compared to the results of randomized controlled trials. The applied endovascular procedures demonstrated high efficacy, but some cellular mechanisms, following reperfusion, are still unknown. Changes in the morphology and function of mitochondria associated with reperfusion and ischemia-reperfusion neuronal death are still understudied research fields. Moreover, future research is needed to elucidate the relationship between continuously refined imaging techniques and the variable structure or physical properties of the clot along with vascular permeability and the pleiotropism of ischemic reperfusion lesions in the penumbra, in order to define targeted preventive procedures promoting long-term health benefits.

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A Prospective Economic Evaluation of Rapid Endovascular Therapy for Acute Ischemic Stroke

Cited by 3 publications

References 29 publications

Return on Investment in Endovascular Care: The Case of Endovascular Reperfusion Alberta

Return on Investment in Endovascular Care: The Case of Endovascular Reperfusion Alberta

Cost-effectiveness of endovascular thrombectomy with alteplase versus endovascular thrombectomy alone for acute ischemic stroke secondary to large vessel occlusion

The Assessment of Endovascular Therapies in Ischemic Stroke: Management, Problems and Future Approaches

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