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van Voorst, Henk; Hoving, Jan W.; Koopman, Miou S.; Daems, Jasper D.; Peerlings, Daan; Buskens, Erik; Lingsma, Hester F.; Beenen, Ludo F. M.; de Jong, Hugo W. A. M.; Berkhemer, Olvert A.; van Zwam, Wim H.; Roos, Yvo B. W. E. M.; van Walderveen, Marianne A. A.; van den Wijngaard, Ido; Dippel, Diederik W. J.; Yoo, Albert J.; Campbell, Bruce C. V.; Kunz, Wolfgang G.; Emmer, Bart J.; Majoie, Charles B. L. M.; van Nuland, Rick; van der Lugt, Aad; van Es, Adriaan; van Doormaal, Pieter-Jan; [...]

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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  • Media type: E-Article
  • Title: 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
  • Contributor: van Voorst, Henk; Hoving, Jan W.; Koopman, Miou S.; Daems, Jasper D.; Peerlings, Daan; Buskens, Erik; Lingsma, Hester F.; Beenen, Ludo F. M.; de Jong, Hugo W. A. M.; Berkhemer, Olvert A.; van Zwam, Wim H.; Roos, Yvo B. W. E. M.; van Walderveen, Marianne A. A.; van den Wijngaard, Ido; Dippel, Diederik W. J.; Yoo, Albert J.; Campbell, Bruce C. V.; Kunz, Wolfgang G.; Emmer, Bart J.; Majoie, Charles B. L. M.; van Nuland, Rick; van der Lugt, Aad; van Es, Adriaan; van Doormaal, Pieter-Jan; [...]
  • imprint: Springer Science and Business Media LLC, 2023
  • Published in: European Radiology
  • Language: English
  • DOI: 10.1007/s00330-023-10119-y
  • ISSN: 1432-1084
  • Keywords: Radiology, Nuclear Medicine and imaging ; General Medicine
  • Origination:
  • Footnote:
  • Description: <jats:title>Abstract</jats:title><jats:sec> <jats:title>Objectives</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>CTP-based screening of suspected stroke patients for an endovascular treatment eligible large vessel occlusion was cost-effective.</jats:p> </jats:sec><jats:sec> <jats:title>Clinical relevance statement.</jats:title> <jats:p>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.</jats:p> </jats:sec><jats:sec> <jats:title>Key Points</jats:title> <jats:p><jats:italic>• Using CT perfusion to detect an endovascular treatment-eligible occlusions resulted in a health gain and cost savings during 10 years of follow-up.</jats:italic></jats:p> <jats:p><jats:italic>• 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).</jats:italic></jats:p> <jats:p><jats:italic>• 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.</jats:italic></jats:p> </jats:sec>