• Medientyp: E-Artikel
  • Titel: Cost-effectiveness of endovascular treatment versus best medical management in basilar artery occlusion stroke : a U.S. healthcare perspective: original research article
  • Beteiligte: Mehrens, Dirk [Verfasser:in]; Fabritius, Matthias P. [Verfasser:in]; Reidler, Paul [Verfasser:in]; Liebig, Thomas [Verfasser:in]; Afat, Saif [Verfasser:in]; Ospel, Johanna Maria [Verfasser:in]; Froelich, Matthias F. [Verfasser:in]; Schwarting, Julian [Verfasser:in]; Ricke, Jens [Verfasser:in]; Dimitriadis, Konstantinos [Verfasser:in]; Goyal, Mayank [Verfasser:in]; Kunz, Wolfgang Gerhard [Verfasser:in]
  • Erschienen: March 2024
  • Erschienen in: European stroke journal ; 9(2024), 1 vom: März, Seite 97-104
  • Sprache: Englisch
  • DOI: 10.1177/23969873231209616
  • Identifikator:
  • Entstehung:
  • Anmerkungen: Online veröffentlicht: 31. Oktober 2023
  • Beschreibung: Introduction: Two recent studies showed clinical benefit for endovascular treatment (EVT) in basilar artery occlusion (BAO) stroke up to 12 h (ATTENTION) and between 6 and 24 h from onset (BAOCHE). Our aim was to investigate the cost-effectiveness of EVT from a U.S. healthcare perspective. - Materials and Methods: Clinical input data were available for both trials, which were analyzed separately. A decision model was built consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a healthcare and a societal perspective. Incremental cost-effectiveness ratios (ICER) were calculated, deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed. - Results: EVT in addition to best medical management (BMM) resulted in additional lifetime costs of $32,063 in the ATTENTION trial and lifetime cost savings of $7690 in the BAOCHE trial (societal perspective). From a healthcare perspective, EVT led to incremental costs and effectiveness of $37,389 and 2.0 QALYs (ATTENTION) as well as $3516 and 1.9 QALYs (BAOCHE), compared to BMM alone. The ICER values were $−4052/QALY (BAOCHE) and $15,867/QALY (ATTENTION) from a societal perspective. In each trial, PSA showed EVT to be cost-effective in most calculations (99.9%) for a willingness-to-pay threshold of $100,000/QALY. Cost of EVT and age at stroke represented the greatest impact on the ICER. - Discussion: From an economic standpoint with a lifetime horizon, EVT in addition to BMM is estimated to be highly effective and cost-effective in BAO stroke.
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