Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

Voorst, Henk van; Kunz, Wolfgang G.; Berg, Lucie A. van den; Kappelhof, Manon; Pinckaers, Florentina M.E.; Goyal, Mayank; Hunink, M. G. Myriam; Emmer, Bart J.; Mulder, Maxim J.H.L.; Dippel, Diederik W.J.; Coutinho, Jonathan M.; Marquering, Henk A.; Boogaarts, Hieronymus D.; Lugt, Aad van der; Zwam, Wim H. van; Roos, Yvo B.W.E.M.; Buskens, Erik; Dijkgraaf, Marcel G. W.; Majoie, Charles B. L. M.

doi:10.1136/neurintsurg-2020-017017

Cited by 11 publications

(29 citation statements)

References 28 publications

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“…The 5-year follow-up period was chosen based on the availability of cohorts for evaluating the forecasted mRS up to 5 years. 14 Moreover, simulating effects beyond 5 years would introduce an exponentially increasing error in the mRS forecasts which becomes even more prominent due to the high baseline age (median MR CLEAN-NO IV cohort included in CLEOPATRA: 71 (IQR 61–79) years old) and concurrent relatively short life expectancy of the selected population. The model will exist of a short-term part simulating mRS at 90 days and a long-term part simulating the yearly mRS decay.…”

Section: Methodsmentioning

confidence: 99%

“…Similar to our previous work, mRS subscores will be used as health states with related costs and QALYs per unit of time per health state. 14 Cohorts will be simulated based on patient-level micro-simulations to relate baseline characteristics to cost-effectiveness outcomes. The health state transition model is depicted in Figure 1.…”

Section: Model Designmentioning

confidence: 99%

“…Acute care costs will be inflated by 42% to attribute to overhead costs as is the Dutch standard for cost pricing. 20 Similar to previous studies by van Voorst et al 14 and van den Berg et al, 18 follow-up costs and index hospital admission costs beyond interventions were combined into groups representing costs made in (1) the first year post-stroke, (2) the second year post-stroke, and (3) the third year and onward. These costs include: in-hospital care, outpatient clinic visits, rehabilitation, formal homecare, and long-term institutionalized care.…”

Section: Costs and Qalysmentioning

confidence: 99%

“…For a more fine-grained description of the costs, we refer to previously published data. 14,18 The simulated mRS score over a period of 5 years will be used to compute cumulative costs and QALYs discounted to present values with annual compound interest rates of 1.5% and 4%, respectively. 20 Costs of healthcare will increase with forecasted inflation rates adapted from the Dutch Ministry of Health, Welfare, and Sport.…”

Section: Costs and Qalysmentioning

confidence: 99%

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Cost-effectiveness of CT perfusion for patients with acute ischemic stroke (CLEOPATRA)-Study protocol for a healthcare evaluation study

Koopman

Hoving

Voorst

et al. 2022

European Stroke Journal

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Introduction: Computed tomography perfusion (CTP) is variably considered to assess eligibility for endovascular thrombectomy (EVT) in acute ischemic (AIS) stroke patients. Although CTP is recommended for patient selection in later (6–24 h) time window, it is currently not recommended in the earlier (0–6 h) time window and the costs and health effects of including CTP for EVT selection remain unknown. We aim to estimate the costs and health effects of using CTP for EVT selection in AIS patients compared to conventional selection. Patients and methods: CLEOPATRA is a healthcare evaluation study using clinical and imaging data from multiple, prospective EVT trials and registries in both the earlier and later time windows. To study the long-term health and cost effects, we will construct a (“Markov”) health state transition model simulating the clinical outcome over a 5-year follow-up period for CTP-based and conventional selection for EVT. Clinical data acquired within the current study and estimates from the literature will be used as input for probabilities of events, costs, and Quality-Adjusted Life Years (QALYs) per modified Rankin Scale (mRS) subscore. Primary outcome for the cost-effectiveness analysis will be the Incremental Cost-Effectiveness Ratio (ICER) in terms of costs per QALY gained over the simulated follow-up period. Study outcomes: Outcome measures will be reported as cumulative values over a 5-year follow-up period. Discussion: This study will provide preliminary insight into costs and health effects of including CTP in the selection for EVT for AIS patients, presenting between 0 and 24 h after time last known well. The results may be used to develop recommendations and inform further implementation projects and studies.

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Section: Methodsmentioning

confidence: 99%

Section: Model Designmentioning

confidence: 99%

Section: Costs and Qalysmentioning

confidence: 99%

Section: Costs and Qalysmentioning

confidence: 99%

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Cost-effectiveness of CT perfusion for patients with acute ischemic stroke (CLEOPATRA)-Study protocol for a healthcare evaluation study

Koopman

Hoving

Voorst

et al. 2022

European Stroke Journal

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“…In this study we reported a wide variety of sensitivity differences as the current evidence comparing NCCT+CTA+CTP with NCCT+CTA based LVO detection is limited by a small sample size and suboptimal research designs (1)(2)(3)(4). Third, we used conservative ORs for the EVT treatment effect based on the MR CLEAN trial (12). In recent years, EVT workflows have improved, improving the treatment effect of EVT (24).…”

Section: Probabilistic Sensitivity Analysismentioning

confidence: 99%

Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: A model-based health economic evaluation study

Voorst¹,

Hoving²,

Koopman³

et al. 2023

Preprint

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Background: CT perfusion (CTP) has been suggested to increase the rate of large vessel occlusion (LVO) detection in patients suspected of acute ischemic stroke (AIS) if used in addition to a standard diagnostic imaging regime of CT angiography (CTA) and non-contrast CT (NCCT). The aim of this study was to estimate the costs and health effects of additional CTP for endovascular treatment (EVT)-eligible occlusion detection using model-based analyses. Methods: In this Dutch, nationwide retrospective cohort study with model-based health economic evaluation, data from 701 EVT-treated patients with available CTP results were included (January 2018 - March 2022; trialregister.nl:NL7974). We compared a cohort undergoing NCCT, CTA, and CTP (NCCT+CTA+CTP) with a generated counterfactual where NCCT and CTA (NCCT+CTA) were used for LVO detection. The NCCT+CTA strategy was simulated using diagnostic accuracy values and EVT effects from the literature. A Markov model was used to simulate 10-year follow-up. We adopted a healthcare payer perspective for costs in euros and health gains in quality-adjusted life years (QALYs). The primary outcome was the net monetary benefit (NMB) at a willingness to pay of 80,000 Euro, secondary outcomes were the difference between LVO detection strategies in QALYs (dQALY) and costs (dCosts). Results: We included 701 patients (median age:72 IQR:[62-81]) years). Per LVO patient, CTP-based occlusion detection resulted in cost savings (dCosts median:-2671 IQR:[-4721;-731] Euro), a health gain (dQALY median:0.073 IQR:[0.044;0.104]), and a positive NMB (median:8436 IQR:[5565;11876]) per LVO patient. Conclusion: Adding CTP to NCCT and CTA for EVT-eligible LVO detection resulted in cost savings and health gains.

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Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study

van Voorst,

Hoving,

Koopman

et al. 2023

Eur Radiol

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Objectives CT perfusion (CTP) has been suggested to increase the rate of large vessel occlusion (LVO) detection in patients suspected of acute ischemic stroke (AIS) if used in addition to a standard diagnostic imaging regime of CT angiography (CTA) and non-contrast CT (NCCT). The aim of this study was to estimate the costs and health effects of additional CTP for endovascular treatment (EVT)–eligible occlusion detection using model-based analyses. Methods In this Dutch, nationwide retrospective cohort study with model-based health economic evaluation, data from 701 EVT-treated patients with available CTP results were included (January 2018–March 2022; trialregister.nl:NL7974). We compared a cohort undergoing NCCT, CTA, and CTP (NCCT + CTA + CTP) with a generated counterfactual where NCCT and CTA (NCCT + CTA) was used for LVO detection. The NCCT + CTA strategy was simulated using diagnostic accuracy values and EVT effects from the literature. A Markov model was used to simulate 10-year follow-up. We adopted a healthcare payer perspective for costs in euros and health gains in quality-adjusted life years (QALYs). The primary outcome was the net monetary benefit (NMB) at a willingness to pay of €80,000; secondary outcomes were the difference between LVO detection strategies in QALYs (ΔQALY) and costs (ΔCosts) per LVO patient. Results We included 701 patients (median age: 72, IQR: [62–81]) years). Per LVO patient, CTP-based occlusion detection resulted in cost savings (ΔCosts median: € − 2671, IQR: [€ − 4721; € − 731]), a health gain (ΔQALY median: 0.073, IQR: [0.044; 0.104]), and a positive NMB (median: €8436, IQR: [5565; 11,876]) per LVO patient. Conclusion CTP-based screening of suspected stroke patients for an endovascular treatment eligible large vessel occlusion was cost-effective. Clinical relevance statement. Although CTP-based patient selection for endovascular treatment has been recently suggested to result in worse patient outcomes after ischemic stroke, an alternative CTP-based screening for endovascular treatable occlusions is cost-effective. Key Points • Using CT perfusion to detect an endovascular treatment-eligible occlusions resulted in a health gain and cost savings during 10 years of follow-up. • Depending on the screening costs related to the number of patients needed to image with CT perfusion, cost savings could be considerable (median: € − 3857, IQR: [€ − 5907; € − 1916] per patient). • As the gain in quality adjusted life years was most affected by the sensitivity of CT perfusion-based occlusion detection, additional studies for the diagnostic accuracy of CT perfusion for occlusion detection are required.

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Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

Cited by 11 publications

References 28 publications

Cost-effectiveness of CT perfusion for patients with acute ischemic stroke (CLEOPATRA)-Study protocol for a healthcare evaluation study

Cost-effectiveness of CT perfusion for patients with acute ischemic stroke (CLEOPATRA)-Study protocol for a healthcare evaluation study

Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: A model-based health economic evaluation study

Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study

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