Endovascular thrombectomy is cost-effective in acute basilar artery occlusion stroke

Schwarting, Julian; Rühling, Sebastian; Bodden, Jannis; Schwarting, Stéphanie K.; Zimmer, Claus; Mehrens, Dirk; Kirschke, Jan S.; Kunz, Wolfgang G.; Boeckh‐Behrens, Tobias; Froelich, Matthias F.

doi:10.3389/fneur.2023.1185304

Cited by 2 publications

(1 citation statement)

References 29 publications

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“…In BAO cases, MT with a stent retriever is considered the primary therapeutic method. However, only one study investigated the cost-effectiveness of endovascular thrombectomy for acute BAO stroke from the perspective of the US healthcare system [ 35 ]. The study concluded that endovascular treatment was cost-effective for patients with BAO stroke, which aligns with our findings despite the differences in the Markov models used.…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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

View full text Add to dashboard Cite

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Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis

Wang,

Yu,

Zhou

et al. 2023

Front. Neurol.

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ObjectiveThis study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system.MethodsWe conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAO-induced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis’s primary outcome was excellent functional outcome (mRS scores of 0–2), with secondary outcomes being poor functional outcome (mRS scores of 3–5) and death (mRS score of 6). To compare EVT plus SMT’s cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective.ResultsThe meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18–4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67–1.03), p = 0.09, and 0.71 (95% CI, 0.59–0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold.ConclusionCompared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone.

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Endovascular thrombectomy is cost-effective in acute basilar artery occlusion stroke

Cited by 2 publications

References 29 publications

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

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

Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis

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