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

(7 citation statements)

References 28 publications

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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%

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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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Section: Discussionmentioning

confidence: 99%

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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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“…Unlike previous authors of economic analyses assessing the cost-effectiveness of management strategies for ischemic stroke, we did not use health states based on recurrent stroke only in the long-term progression of stroke or dichotomize mRS 0–5 into independence (mRS 0–2) and disability (mRS 3–5) in our models. 17 – 19 , 34 One reason is that stroke survivors can develop multiple events other than recurrent stroke in the long term. The incidence of nonvascular (e.g., seizures) and other, vascular events (e.g., cognitive impairment) in stroke survivors is high, and complex relations exist among these clinical events.…”

Section: Discussionmentioning

confidence: 99%

“…In prior economic analyses, investigators have explored EVT with alteplase versus alteplase alone and concluded that combination therapy was more cost-effective. 17 – 19 There is a lack of evidence on the cost-effectiveness of combination therapy versus EVT alone. To evaluate the cost-effectiveness of EVT with alteplase versus EVT alone and to provide economic evidence for the development of the international guideline, we conducted an economic analysis.…”

mentioning

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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“…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

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

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

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

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

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