Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: A model-based health economic evaluation study

Abstract

Background: CT perfusion (CTP) has been suggested to increase the rate of large vessel occlusion (LVO) detection in patients suspected of acute ischemic stroke (AIS) if used in addition to a standard diagnostic imaging regime of CT angiography (CTA) and non-contrast CT (NCCT). The aim of this study was to estimate the costs and health effects of additional CTP for endovascular treatment (EVT)-eligible occlusion detection using model-based analyses. Methods: In this Dutch, nationwide retrospective cohort study with model-based health economic evaluation, data from 701 EVT-treated patients with available CTP results were included (January 2018 - March 2022; trialregister.nl:NL7974). We compared a cohort undergoing NCCT, CTA, and CTP (NCCT+CTA+CTP) with a generated counterfactual where NCCT and CTA (NCCT+CTA) were used for LVO detection. The NCCT+CTA strategy was simulated using diagnostic accuracy values and EVT effects from the literature. A Markov model was used to simulate 10-year follow-up. We adopted a healthcare payer perspective for costs in euros and health gains in quality-adjusted life years (QALYs). The primary outcome was the net monetary benefit (NMB) at a willingness to pay of 80,000 Euro, secondary outcomes were the difference between LVO detection strategies in QALYs (dQALY) and costs (dCosts). Results: We included 701 patients (median age:72 IQR:[62-81]) years). Per LVO patient, CTP-based occlusion detection resulted in cost savings (dCosts median:-2671 IQR:[-4721;-731] Euro), a health gain (dQALY median:0.073 IQR:[0.044;0.104]), and a positive NMB (median:8436 IQR:[5565;11876]) per LVO patient. Conclusion: Adding CTP to NCCT and CTA for EVT-eligible LVO detection resulted in cost savings and health gains.