Is Endovascular Therapy for Stroke Cost-Effective Globally? A Systematic Review of the Literature

Waqas, Muhammad; Gong, Andrew D.; Levy, Bennett R.; Dossani, Rimal H; Vakharia, Kunal; Cappuzzo, Justin M; Becker, Alexander; Sonig, Ashish; Tutino, Vincent M.; Almayman, Faisal; Davies, Jason M; Snyder, Kenneth V.; Siddiqui, Adnan H.; Levy, Elad I.

doi:10.1016/j.jstrokecerebrovasdis.2020.105557

Cited by 13 publications

(19 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incremental QALYs estimated from this study are in the midrange of the published QALYs gained from EVT in the previous studies which reported QALYs gained between 0.11 in the Netherlands and 3.5 in New Zealand. 22 EVT plus intravenous alteplase was associated with an ICER of 146 800 THB per QALY gained (95% CI 146 300 to 147 300) for alteplase eligible patients, while the ICER of EVT compared with supportive care for alteplase ineligible patients was estimated at 115 000 THB per QALY gained (95% CI of 114 200 to 116 000).…”

Section: Resultsmentioning

confidence: 99%

“…Our findings are consistent with two published systematic reviews of economic evaluations of EVT. 22 23 Most studies in the reviews, conducted across different countries and perspectives, reported EVT to be cost-effective for stroke treatment. Notably, the two studies conducted in Asia (China 24 and Korea 25 ) illustrated good value for money, despite applying different perspectives and time horizons to our study.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the incremental QALY estimates from our model were compared with the results from other studies included in a systematic review of economic evaluations published by Waqas et al . 22 …”

Section: Methodsmentioning

confidence: 99%

“…The second meeting was conducted on 8 February 2022 21 to verify model structure, preliminary results and to endorse policy recommendations. In addition, the incremental QALY estimates from our model were compared with the results from other studies included in a systematic review of economic evaluations published by Waqas et al 22 Patient and public involvement None.…”

Section: Model Validationmentioning

confidence: 99%

See 3 more Smart Citations

Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand

et al. 2022

View full text Add to dashboard Cite

ObjectivesEndovascular therapy (EVT) has proven to be clinically effective in treating large vessel occlusion acute ischaemic stroke (AIS), either alone or in combination with intravenous alteplase. Despite this, there is a limited evidence on the cost-effectiveness of EVT in Thailand and other low-income and middle-income countries. This study aims to assess whether EVT is a cost-effective therapy for AIS, and to estimate the fiscal burden to the Thai government through budget impact analysis.MethodsAn economic evaluation was performed to compare AIS therapy with and without EVT from a societal perspective. The primary outcome was incremental cost-effectiveness per quality-adjusted life year (QALY) gained. Clinical parameters were derived from both national and international literature, while cost and utility data were collected locally. The analysis applied a cost-effectiveness threshold of 160 000 Baht (~$5000) per QALY, as set by the Thai government.ResultsBoth EVT alone and EVT combined with intravenous alteplase, among patients who are ineligible and eligible for intravenous alteplase, respectively, improved health outcomes but incurred additional cost. The combination of EVT and intravenous alteplase was associated with an incremental cost-effectiveness ratio (ICER) of 146 800 THB per QALY gained compared with intravenous alteplase alone, and the ICER of EVT alone compared with supportive care among patients ineligible for intravenous alteplase was estimated at 115 000 THB per QALY gained. Sensitivity analysis showed that the price of EVT has the greatest impact on model outcomes. Over a time horizon of 5 years, the introduction of EVT into the Thai health benefit package would require an additional budget of 887 million THB, assuming 2000 new cases per year.ConclusionsEVT represents good value for money in the Thai context, both when provided to patients eligible for intravenous alteplase, and when provided alone to those who are ineligible for intravenous alteplase.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Model Validationmentioning

confidence: 99%

See 2 more Smart Citations

Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand

et al. 2022

View full text Add to dashboard Cite

show abstract

“…Moreover, it is efficacious in only 30% of the patients 3 , and its use is associated with hemorrhagic transformation in about 5-10% of cases 4 . Thrombectomy is effective over a longer time range, it can be combined with tPA and has a better cost-benefit ratio 5 . However, its widespread implementation will require a considerable investment of resources.…”

Section: Introductionmentioning

confidence: 99%

Factor VII activating protease (FSAP) inhibits the outcome of ischemic stroke in mouse models

Kim

Manna

Leergaard

et al. 2022

Preprint

View full text Add to dashboard Cite

Factor VII activating protease (FSAP) is a circulating serine protease, and individuals with the Marburg I (MI) single nucleotide polymorphism (SNP), which results in an inactive enzyme, have an increased risk of stroke. The outcome of ischemic stroke is more marked in FSAP-deficient mice compared to their wild-type (WT) counterparts. Plasma FSAP levels are raised in patients as well as mice after stroke. In vitro, FSAP promotes fibrinolysis by cleavage of fibrinogen, activates protease-activated receptors and decreases the cellular cytotoxicity of histones. Since these are desirable properties in stroke treatment, we tested the effect of recombinant serine protease domain of FSAP (FSAP-SPD) on ischemic stroke in mice. A combination of tissue plasminogen activator (tPA) and FSAP-SPD enhanced clot lysis, improved microvascular perfusion and neurological outcome and reduced infarct volumes in a mouse model of thromboembolic stroke. In the tail bleeding model FSAP-SPD treatment provoked a faster clotting time indicating that it has a pro-coagulant effect that is described before. FSAP-SPD improved stroke outcome and diminished the negative effects of co-treatment with tPA in the transient middle cerebral artery occlusion model. The inactive MI-isoform of FSAP did not have any effects in either model. In mice with FSAP deficiency there were minor differences in the outcomes of stroke but the treatment with FSAP-SPD was equally effective. Thus, FSAP represents a promising novel therapeutic strategy in the treatment of ischemic stroke that requires further evaluation.

show abstract

Multi-assessment of critical steno-occlusive middle cerebral arteries: transcranial Doppler combined with magnetic resonance angiography

Lin

et al. 2022

Heliyon

View full text Add to dashboard Cite

Is Endovascular Therapy for Stroke Cost-Effective Globally? A Systematic Review of the Literature

Cited by 13 publications

References 41 publications

Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand

Economic evaluation of endovascular treatment for acute ischaemic stroke in Thailand

Factor VII activating protease (FSAP) inhibits the outcome of ischemic stroke in mouse models

Multi-assessment of critical steno-occlusive middle cerebral arteries: transcranial Doppler combined with magnetic resonance angiography

Contact Info

Product

Resources

About