Evaluating the cost-utility of a direct transfer to angiosuite protocol within 6 h of symptom onset in suspected large vessel occlusion patients

Requena, Manuel; Seguel, Valeska; Vilaseca-Jolonch, Andreu; Woods, Jacklyn; Guijarro, Pablo; Ribó, Marc; Molina, Carlos A.

doi:10.1080/13696998.2022.2113221

Cited by 7 publications

(9 citation statements)

References 33 publications

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“…A recent study showed that DTAS is cost-effective from a healthcare system perspective by including a lifetime time horizon, mainly due to long-term costs related to disability 22. In this study we focused on hospital-related costs during the acute and sub-acute phase until 90 days post-procedure, with the aim to provide a contextualized assessment relevant for the hospital setting.…”

Section: Discussionmentioning

confidence: 99%

Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial

Requena

Bavière

Verma

et al. 2023

J NeuroIntervent Surg

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BackgroundThe ANGIOCAT trial showed a clinical benefit of direct to angiography suite (DTAS) for patients with large vessel occlusion (LVO) stroke admitted within 6 hours after symptom onset in decreased hospital workflow time and improved clinical outcome. However, the impact of DTAS implementation on hospital costs is unknown. This economic evaluation aims to assess the cost-utility of DTAS from the provider (hospital) perspective.MethodsA cost-utility analysis was applied to compare DTAS with the standard direct to CT (DTCT) suite approach using direct cost and health outcomes data. The time horizon was 90 days. One-way sensitivity analysis as well as probabilistic sensitivity analysis was performed, varying the model parameters by ±25%. Measures included costs, quality-adjusted life years, and incremental cost-effectiveness ratios. Health outcomes, classified according to the modified Rankin Scale, were obtained from the ANGIOCAT trial. Respective utilities were obtained from the literature.ResultsDTAS is the dominant strategy. The incremental cost-effectiveness ratio is −€89 110 (−$97 600) with cost saving per patient of –€2848 (–$3120). The improved clinical outcome is directly related with a decrease in costs for the hospital, mainly due to the decrease in costs of hospital stay, improved clinical outcome and fewer complications.ConclusionsFor patients with LVO admitted within 6 hours after symptom onset, the DTAS not only improves clinical outcome but also decreases the costs (dominant option) compared with the standard DTCT. Multicentric international randomized clinical trials are ongoing to determine the replicability of our findings.

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Section: Discussionmentioning

confidence: 99%

Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial

Requena

Bavière

Verma

et al. 2023

J NeuroIntervent Surg

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“…Our findings are in line with previously published studies showing that earlier EVT treatment results in more disability-free life. 4,5 A recent study from Spain reported that the DTAS strategy was dominant (lower costs and more QALYs) compared with the ITER strategy, 8 whereas the ICER of DTAS was $24,925 in the Netherlands. Small differences in incremental QALYs were reported in the previous study 8 (0.82 QALYs in lifetime horizon) compared with our findings (0.65 QALYs in 10 years).…”

Section: Discussionmentioning

confidence: 99%

“…4,5 A recent study from Spain reported that the DTAS strategy was dominant (lower costs and more QALYs) compared with the ITER strategy, 8 whereas the ICER of DTAS was $24,925 in the Netherlands. Small differences in incremental QALYs were reported in the previous study 8 (0.82 QALYs in lifetime horizon) compared with our findings (0.65 QALYs in 10 years). However, the DTAS strategy appeared to save €51,505 per patient in Spain while DTAS would add costs ($16,089) in our study.…”

Section: Discussionmentioning

confidence: 99%

“…However, introducing DTAS could result in higher costs and unnecessary occupation of the angiography suite in non-LVO patients and increase the workload for the angiography team. A recent economic evaluation 8 concluded that DTAS was cost-effective in patients with suspected LVO within 6 hours from stroke onset in Spain. Therefore, the aim of this study was to evaluate the cost-effectiveness of DTAS compared with initial transfer to the emergency room (ITER) in patients with suspected LVO from the Dutch health care perspective.…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of Direct Transfer to Angiography Suite of Patients With Suspected Large Vessel Occlusion

Lahr

Zee

Voorst³

et al. 2023

Neurology

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Background and ObjectivesPatients with acute ischemic stroke due to large vessel occlusion (LVO) deemed eligible for endovascular thrombectomy (EVT) are transferred from the emergency room to the angiography suite to undergo the procedure. Recently, the strategy of direct transfer of suspected LVO patients to the angiography suite (DTAS) has been shown to improve functional outcomes. The present study aims to evaluate the cost-effectiveness of the DTAS strategy versus initial transfer of suspected LVO patients (Rapid Arterial Occlusion Evaluation score >4 and National Institutes of Health Stroke Scale > 10) to the emergency room (ITER).MethodsA decision-analytic Markov model was developed to estimate the cost-effectiveness of the DTAS strategy versus the ITER strategy from a Dutch healthcare perspective with a ten-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER) using Dutch thresholds of $59,135 (€50,000) and $94,616 (€80,000) per quality-adjusted life year (QALY). Uncertainty of input parameters was assessed using one-way sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis.ResultsThe DTAS strategy yielded 0.65 additional QALYs at an additional $16,089, resulting in an ICER of $24,925/QALY compared to the ITER strategy. The ICER varied from $27,169 to $38,325/QALY across different scenarios. The probabilistic sensitivity analysis showed that the DTAS strategy had a 91.8% and 97.0% likelihood of being cost-effective at a decision threshold of $59,135/QALY and $94,616/QALY, respectively.DiscussionThe cost-effectiveness of the DTAS strategy over ITER is robust for suspected LVO patients. Together with recently published clinical results, this means that implementation of the DTAS strategy may be considered to improve the workflow and outcome of EVT.

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“…They found that the DTA approach was associated with significantly lower hospital costs after controlling for demographic and stroke clinical characteristics ($6694 less [95% CI, $1614 to $11 773]; P =0.01). 71 Further, Requena et al 72 demonstrated that cost savings in DTA patients amounted to ≈10% of total stroke care costs and were largely attributable to better patient outcomes. Another consideration with regard to DTA would be the availability of the angio suite during elective procedural hours and the development of a dedicated angio suite exclusively for the management of suspected acute stroke patients.…”

Section: Other Benefits Of Dtamentioning

confidence: 99%

Direct Transfer to the Neuroangiography Suite for Patients With Stroke

Desai

Psychogios

Khatri

et al. 2023

Stroke

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The therapeutic focus in acute ischemic stroke over the last 2.5 decades has been to balance the benefits of rapid reperfusion therapy with the risks of treatment-related complications. Both intravenous thrombolytics and endovascular thrombectomy are proven to substantially improve outcomes in a time-dependent manner. Each minute saved in achieving successful reperfusion grants an additional week of healthy life and may salvage up to 27 million neurons. The current approach to patient triage is inherited from the preendovascular thrombectomy era of stroke care. Current workflow concentrates on stabilization, diagnosis, and decision-making in the emergency department, followed by thrombolysis if eligible and subsequent transfer to the angiography suite as needed for further treatment. Multiple efforts have been directed toward minimizing the time from first medical contact to reperfusion therapy including prehospital triage and intrahospital workflow. Novel approaches for stroke patient triage such as the direct to angio approach, (also referred to as One Stop Management) are currently in development. The concept was initially introduced as several single-center experiences. In this narrative review article, we will consider various definitions of direct to angio and its variants, discuss its rationale, review its safety and efficacy, assess its feasibility, and delineate its limitations. Further, we will address methods to overcome these limitations and the potential impact of emerging data and new technologies on the direct-to-angio approach.

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Evaluating the cost-utility of a direct transfer to angiosuite protocol within 6 h of symptom onset in suspected large vessel occlusion patients

Cited by 7 publications

References 33 publications

Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial

Cost-utility of direct transfer to angiography suite (DTAS) bypassing conventional imaging for patients with acute ischemic stroke in Spain: results from the ANGIOCAT trial

Cost-effectiveness of Direct Transfer to Angiography Suite of Patients With Suspected Large Vessel Occlusion

Direct Transfer to the Neuroangiography Suite for Patients With Stroke

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