Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Andrés-Nogales, F. de; Álvarez, María; Miquel, María Ángeles de; Segura, Tomás; Gil, Alberto; Cardona, Pere; Casado, Miguel; Nogueira, Raul G; Dávalos, Antoni

doi:10.1177/2396987317721865

Cited by 22 publications

(21 citation statements)

References 46 publications

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“…In a Spanish cost analysis study, also using real-life resources, the cost of MT including predominantly SR devices with consumables and staffing was equivalent to £5,980. 23 In a Norwegian health technology assessment, the estimated costs of MT including the procedure, diagnostical imaging and transport were estimated to be £5,919, substantially lower that the estimate in our study of these same components of £8,750. 24 The higher MT costs in some of the economic analyses above compared with this current study, where a mixture of devices were used, could be related to the predominant use of SR devices for MT.…”

Section: Discussioncontrasting

confidence: 63%

The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

et al. 2020

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Method This was a multicentre retrospective study using microcosting methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018. Results Data were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527-11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649-8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381-1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345-2,719; p<0001).

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Section: Discussioncontrasting

confidence: 63%

The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

et al. 2020

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“…According to WFR, on the first day after treatment, patients showed the greatest difficulties with mobility and locomotion, namely with sitting on a toilet and going up the stairs. The smallest problem was communication, which is associated with the emerging aphasia, which is the second most frequent symptom of focal brain damage according to the authors [33]. The distribution of results on this scale was very similar on the 1 st and 9 th day of treatment.…”

Section: Discussionmentioning

confidence: 75%

Endovascular and Thrombolytic Therapy and the Functional Status of Patients after Ischemic Stroke

Jabłońska

Wronkowska

Ślusarz

et al. 2019

PNIN

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Introduction. Stroke is treated as a direct threat to life. Mechanical thrombectomy used as an independent treatment or in combination with systemic thrombolysis is currently the standard care in the treatment of ischemic stroke. Aim. Evaluation of the functional status of patients after ischemic stroke treated with thrombolysis or thrombectomy. Material and Methods. The study involved 50 patients hospitalized due to ischemic stroke. Standardized research tools were used: the Rankin scale, the Barthel scale and the Functional Index "Repty" (WFR). The study was conducted twice in one patient: on the first and ninth day after the treatment. The collected material was developed statistically. Results. Most of the respondents were men-62%. Thrombolytic treatment was used in all subjects, and thrombectomy in 26% people. Analyses showed that there were differences in the Barthel scale level Z = 4.87; p < 0.001, Rankin Z = 4.80; p < 0.001 and WFR Z = 4.83; p < 0.001. The age of the respondents was related negatively to the Barthel scale score on the 1 st day ρ =-0.51; p < 0.001 and the 9 th day ρ =-0.53; p < 0.001 and the result in the WFR scale on the 1 st day ρ =-0.54; p < 0.001 and the 9 th day ρ =-0.52; p < 0.001. Conclusions. The performance of the subjects on the 1st day of treatment was worse than on the 9th day. People who were only treated with thrombolysis had better results in fitness tests and had a lower level of disability than people treated with thrombolysis and thrombectomy.

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“…Most of the economic evaluations concluded that EVT was a dominant treatment option (i.e., higher QALYs and lower costs) for patients with ischemic stroke, while the rest reported its positive cost-effectiveness (i.e., ICER falls below the WTP/QALY threshold for various jurisdictions), including late window EVT (studies listed in Supplementary Table X ). The gains in QALYs from these studies ranged from 0.54 ( 43 ) to 2.51 ( 46 ) over the lifetime horizon. However, positive cost-effectiveness outcomes that are built upon efficacy outcomes from clinical trials may misinform clinical and policy decision-making, thereby leading to inappropriate management of patients with ischemic stroke.…”

Section: Discussionmentioning

confidence: 95%

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

et al. 2021

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Background: To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for patients with ischemic stroke in the >4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria.Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in patients meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, vs. medical treatment alone (including intravenous thrombolysis). The effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischemic stroke, between 2015 and 2019, in the extended time window (>4.5 h).Results: Endovascular thrombectomy was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort [incremental cost-effectiveness ratio (ICER) of $11,608/quality-adjusted life year (QALY) for DEFUSE 3-postive or $34,416/QALY for DAWN-positive]. However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (−1.02 QALY for DEFUSE 3; −1.43 QALY for DAWN) and higher long-term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), thereby making it unlikely to be cost-effective in Australia.Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.

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Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Cited by 22 publications

References 46 publications

The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

Endovascular and Thrombolytic Therapy and the Functional Status of Patients after Ischemic Stroke

Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

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