Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study

Andrés-Nogales, F. de; Mora, José Vivancos; Hernández, F.J. Barriga; Otero, Francisco Javier Sanjiao; Esteban, L. Izquierdo; Ortega-Casarrubios, M A; Moreno, L. Castillo; Rico, Alex; Torres, Marcela; Escobar, Cristina; González, C. Torres; Salas-Cansado, Marina de; Gómez, Miguel Ángel; Álvarez, Javier Soto; Gil‐Núñez, A.

doi:10.1016/j.nrleng.2014.06.001

Cited by 7 publications

(10 citation statements)

References 23 publications

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“…25,[27][28][29][30] Acute, long-term management and formal care cost were broken down by mRS score 28,29 ( Table 2). However, available costs were reported using various categories (minor [mRS 0-2] or major stroke [mRS [3][4][5] for acute management costs and by dependency level [Barthel index score] for long-term management costs). Thus, available costs were weighted by AE10%, as necessary, to allow to discriminate acute costs between health states.…”

Section: Quality Of Lifementioning

confidence: 99%

“…3 Another study estimated the cost of acute management and rehabilitation of cardioembolic stroke patients in E13,139, with the highest costs related to hospital stay and rehabilitation therapies. 4 For the last 20 years, the only evidence-based therapy for acute ischaemic stroke was intravenous tissue plasminogen activator (IV t-PA), administered within 3 h or up to 4.5 h after ischaemic stroke. 5,6 Recent randomised clinical trials demonstrated the efficacy of adding mechanical thrombectomy to IV t-PA, [7][8][9][10][11] which led European scientific societies to recommend mechanical thrombectomy, primarily with stent retrievers, after intravenous thrombolysis within 4.5 h if eligible, for the treatment of acute stroke patients with large artery occlusions in the anterior circulation within 6 h 12 or even up to 8 h after symptom onset.…”

Section: Introductionmentioning

confidence: 99%

“…3 Another study estimated the cost of acute management and rehabilitation of cardioembolic stroke patients in €13,139, with the highest costs related to hospital stay and rehabilitation therapies. 4…”

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Andrés-Nogales

Álvarez

Miquel

et al. 2017

European Stroke Journal

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Introduction: To assess the cost-effectiveness of stent-retriever mechanical thrombectomy and intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in patients with acute ischaemic stroke due to large vessel occlusions in Spain. Materials and methods: Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). A Spanish National Health System perspective (direct medical costs) was considered. Resource utilisation and utilities were obtained from available published data and endorsed by an expert panel. Costs (E, 2016) were obtained from various Spanish sources. Deterministic and probabilistic sensitivity analyses were performed. Results: Stent-retriever thrombectomy after intravenous tissue plasminogen activator was associated with better outcomes (1.17 life years gained and 2.51 quality adjusted life years) and savings of E44,378, resulting in a dominant therapy over intravenous tissue plasminogen activator alone. A net monetary benefit of E119,744 was obtained considering a willingness-to-pay threshold of E30,000/quality adjusted life year gained. The combined therapy was also dominant in all sensitivity analyses, deterministic and probabilistic. Discussion: The results were consistent with a previously published cost-effectiveness analysis and reinforce the likeliness of the selection of stent-retriever mechanical thrombectomy plus intravenous tissue plasminogen activator over intravenous tissue plasminogen activator alone. Conclusion: Stent-retriever thrombectomy after intravenous tissue plasminogen activator is a dominant alternative over intravenous tissue plasminogen activator alone (more effective and less costly) for the treatment of acute ischaemic stroke patients with large vessel occlusions in the Spanish setting.

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Section: Quality Of Lifementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Andrés-Nogales

Álvarez

Miquel

et al. 2017

European Stroke Journal

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“…UU.) 27 Análisis retrospectivo (2005-2011) C 23.807 pacientes con FA vs. 136.649 sin FA Costes totales en pacientes con FA que sufren un ictus $20,933 ± 20% en los costes totales con la presencia de FA De Andres-Nogales et al, 2014 (España) 28 Observacional prospectivo multicéntrico C 128 casos Consumo de servicios sanitarios por ictus cardioembólico asociado a FA ( CODICE Study ) 13.420 €/paciente/año Zhang et al, 2017 EE. UU.)…”

Section: Resultsunclassified

“…Su abordaje muestra diferencias en el porcentaje de costos relacionados con la prevención primaria entre 8,8-13% de los costes totales. El tratamiento de la FA tiene un coste medio de 4.750-23.064 €/paciente/año 22 , 23 , 24 , de los que un tercio son atribuibles al manejo de la anticoagulación 22 , 23 , 24 , 25 , 26 , 27 , 28 . Las complicaciones cardiovasculares 5 , 6 , 25 y el ictus isquémico 26 , 27 , 28 en pacientes con FA añade 20% de coste, multiplicándose por 2,3 en pacientes ≥ 75 años 27 .…”

Section: Resultsunclassified

Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura

Lucas-Noll¹,

Lleixà-Fortuño²,

Queralt-Tomas³

et al. 2023

Atención Primaria

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Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients

et al. 2022

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Objectives Stroke treatment with intravenous tissue-type plasminogen activator (tPA) is effective and efficient, but as its benefits are highly time dependent, it is essential to treat the patient promptly after symptom onset. This study evaluates the cost-effectiveness of a blood biomarker test to differentiate ischemic and hemorrhagic stroke to guide pre-hospital treatment with tPA in patients with suspected stroke, compared with standard hospital management. The standard care for patients suffering stroke consists mainly in diagnosis, treatment, hospitalization and monitoring. Methods A Markov model was built with four health states according to the modified Rankin scale, in adult patients with suspected moderate to severe stroke (NIHSS 4-22) within 4.5 hours after symptom onset. A Spanish Health System perspective was used. The time horizon was 15 years. Quality-adjusted life-years (QALYs) and life-years gained (LYGs) were used as a measure of effectiveness. Short- and long-term direct health costs were included. Costs were expressed in Euros (2022). A discount rate of 3% was used. Probabilistic sensitivity analysis and several one-way sensitivity analyses were conducted. Results The use of a blood-test biomarker compared with standard care was associated with more QALYs (4.87 vs. 4.77), more LYGs (7.18 vs. 7.07), and greater costs (12,807€ vs. 12,713€). The ICER was 881€/QALY. Probabilistic sensitivity analysis showed that the biomarker test was cost-effective in 82% of iterations using a threshold of 24,000€/QALY. Conclusions The use of a blood biomarker test to guide pre-hospital thrombolysis is cost-effective compared with standard hospital care in patients with ischemic stroke.

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Use of healthcare resources and costs of acute cardioembolic stroke management in the Region of Madrid: The CODICE Study

Cited by 7 publications

References 23 publications

Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Cost-effectiveness of mechanical thrombectomy using stent retriever after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone in the treatment of acute ischaemic stroke due to large vessel occlusion in Spain

Organización y costes de la atención extrahospitalaria del ictus. Revisión sistemática de la literatura

Modeling the potential efficiency of a blood biomarker-based tool to guide pre-hospital thrombolytic therapy in stroke patients

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