Cost-effectiveness of stent-retriever thrombectomy in large vessel occlusion strokes of the anterior circulation: Analysis from the French societal perspective

Barral, Marine; Armoiry, Xavier; Boudour, Sofia; Aulagner, G.; Schott, Anne-Marie; Turjman, Francis; Gory, Benjamin; Viprey, Marie

doi:10.1016/j.neurol.2019.06.007

Cited by 9 publications

(8 citation statements)

References 28 publications

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“…For example, MT was performed at lower costs in a lifetime horizon versus thrombolysis in Chile, and with higher benefits (2.63 incremental QALYs) [ 35 ]. Related studies were also consistent in adding stent retriever thrombectomy, globally (0.73 incremental QALYs in France) [ 36 ]. American research showed adding thrombectomy with stent retrievers to guideline-based care (including IVT) resulted in a gain of 0.99 QALYs with a cost savings of approximately $221 per patient [ 12 ].…”

Section: Discussionmentioning

confidence: 62%

Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula

Han,

Lan,

Kou

et al. 2024

Health Econ Rev

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Background Recently, the endovascular treatment (EVT) of acute ischemic stroke has made significant progress in many aspects. Intravenous thrombolysis (IVT) is usually recommended before endovascular treatment in clinical practice, but the value of the practice is controversial. The latest meta-analysis evaluation was that the effect of EVT versus EVT plus IVT did not differ significantly. The cost-effectiveness analysis of EVT plus IVT needs further analysis. This study assesses the health benefits and economic impact of EVT plus IVT in Shandong Peninsula of China. Method We followed a cross-section design using the Chinese-Shandong Peninsula public hospital database between 2013 and 2023. The real-world costs and health outcomes were collected through the Hospital Information System (HIS) and published references. We calculated incremental cost-effectiveness ratios (ICERs) from the perspective of Chinese healthcare using the complex decision model to compare the costs and effectiveness between EVT versus EVT + IVT. One-way and Monte Carlo probabilistic sensitivity analyses were performed to assess the robustness of the economic evaluation model. Results EVT alone had a lower cost compared with EVT + IVT whether short-term or long-term. Until 99% dead of AIS patients, the ICER per additional QALY was RMB696399.30 over the willingness-to-pay (WTP) threshold of 3× gross domestic product (GDP) per capita in Shandong. The probabilistic sensitivity analysis of 3 months, 1 year and long-term horizons had a 97.90%, 97.43% and 96.89% probability of cost-effective treatment under the WTP threshold (1×GDP). The results of the one-way sensitivity analysis showed that direct treatment costs for EVT alone and EVT + IVT were all sensitive to ICER. Conclusions EVT alone was more cost-effective treatment compared to EVT + IVT in the Northeast Coastal Area of China. The data of this study could be used as a reference in China, and the use of the evaluation in other regions should be carefully considered.

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Section: Discussionmentioning

confidence: 62%

Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula

Han,

Lan,

Kou

et al. 2024

Health Econ Rev

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“…Whereas the availability of reimbursement for MT was not associated with MT access, a robust effort to make MT affordable is of critical need in LMIC. Despite high upfront cost of the MT procedure and devices, it has been shown to be cost-effective from both a societal and a health care system perspective [98][99][100][101] in HIC as well as middle-income countries and in the <6-hour and the 6-to 24-hour treatment window. [102][103][104] In LMIC, health financing systems rely heavily on out-of-pocket payments, which can put a tremendous burden on households, increasing the risk of catastrophic (defined as payments >25% of the total household budget) or impoverishing (when payments push a household's other spending below a minimum socially recognized living standard) expenditures.…”

Section: Discussionmentioning

confidence: 99%

“…9 Moreover, MT has been found to be cost-effective. [10][11][12][13][14][15] Whereas improving stroke care overall remains essential, 16 the substantial benefit of MT in reducing LVO-related disability and cost begets the need to understand LVO treatment delivery and to enhance its access. Comprehensive comparative global data on the access and delivery of MT are lacking.…”

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confidence: 99%

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

et al. 2023

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Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was <1.0% for 18 (27%) countries and 0 for 7 (10%) countries. There was a 460-fold disparity between the highest and lowest nonzero MTA regions and low-income countries had 88% lower MTA compared with high-income countries. The global MT operator availability was 16.5% of optimal and the MT center availability was 20.8% of optimal. On multivariable regression, country income level (low or lower–middle versus high: odds ratio, 0.08 [95% CI, 0.04–0.12]), MT operator availability (odds ratio, 3.35 [95% CI, 2.07–5.42]), MT center availability (odds ratio, 2.86 [95% CI, 1.84–4.48]), and presence of prehospital acute stroke bypass protocol (odds ratio, 4.00 [95% CI, 1.70–9.42]) were significantly associated with increased odds of MTA. Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

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“…Previous studies have consistently demonstrated the efficacy of using a SR in MT for anterior circulation occlusion [ 33 , 34 ]. Furthermore, the cost-effectiveness of this therapy has been confirmed in various countries and regions [ 10 , 11 , 23 , 26 ], even when performed >6 h after symptom onset [ 9 , 10 ]. In BAO cases, MT with a stent retriever is considered the primary therapeutic method.…”

Section: Discussionmentioning

confidence: 99%

“…Third, the long-term outcomes were assumed to depend solely on the mRS scores at 3 months, regardless of whether SR was performed. Previous studies have adopted such assumptions [ 9 , 23 , 24 ].…”

Section: Methodsmentioning

confidence: 99%

Economic evaluation of stent retrievers in basilar artery occlusion: An analysis from Chinese healthcare system perspective

Xia,

Yang,

Wang

et al. 2023

PLoS ONE

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Purpose This study aimed to investigate the cost-effectiveness of stent retriever (SR) versus best medical management (BMM) in patients with basilar artery occlusion (BAO) in China. Methods We used a two-step approach to compare the cost-effectiveness of SR plus BMM with that of BMM alone over 20 years. A decision tree was initially constructed for the first 3 months, followed by a Markov model for the subsequent period. Collected data on clinical aspects were extracted from the BAOCHE investigation, while costs-related information was sourced from previously published research. The key metric for evaluating the primary outcome was the incremental cost-effectiveness ratio (ICER), achieved $/QALY. The threshold for identifying SR as highly cost-effective was set at an ICER below $12,551/QALY, SR was deemed cost-effective if the ICER ranged from $12,551 to $37,654 per QALY. Uncertainty was addressed using scenario, one-way sensitivity, and probabilistic sensitivity analyses (PSA). Findings For Chinese patients with BAO, the 20-year cost per patient was $8678 with BMM alone and $21,988 for SR plus BMM. Effectiveness was 1.45 QALY for BMM alone, and 2.77 QALY for SR plus BMM. The ICER of SR + BMM versus BMM alone was $10,050 per QALY. The scenario and one-way sensitivity analyses revealed that in certain situations the ICER could exceed $12,551 per QALY, but remain below $37,654 per QALY. Results from the PSA suggested that SR was likely to be cost-effective for Chinese patients with BAO, with a probability exceeding 98% when considering a willingness-to-pay (WTP) threshold of $12,551 per QALY. Implications Our study indicates that SR is an intervention option that is highly likely to be cost-effective for Chinese patients with BAO, with a probability of over 98% under the current WTP threshold of $12,551 per QALY.

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Cost-effectiveness of stent-retriever thrombectomy in large vessel occlusion strokes of the anterior circulation: Analysis from the French societal perspective

Cited by 9 publications

References 28 publications

Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula

Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

Economic evaluation of stent retrievers in basilar artery occlusion: An analysis from Chinese healthcare system perspective

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