Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial.

Autor:	de Souza AC; Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Martins SO; Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Polanczyk CA; National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil., Araújo DV; Medical School, State University of Rio de Janeiro, Rio de Janeiro, Brazil., Etges APB; National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil., Zanotto BS; National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil., Neyeloff JL; National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil., Carbonera LA; Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Chaves MLF; Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., de Carvalho JJF; Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil.; Department of Neurology, University of Fortaleza, Fortaleza, Brazil., Rebello LC; Department of Neurology, 283325Hospital de Base do Distrito Federal, Brasilia, Brazil., Abud DG; Department of Interventional Neuroradiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Cabral LS; Department of Interventional Neuroradiology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil., Lima FO; Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil., Mont'Alverne F; Department of Neurology, Hospital Geral de Fortaleza, Fortaleza, Brazil.; Department of Interventional Neuroradiology, Hospital Geral de Fortaleza, Fortaleza, Brazil.; Department of Post-Graduation Medical Sciences, University of Fortaleza, Fortaleza, Brazil., Sc Magalhães P; Stroke Neurology Division, Hospital Municipal de Joinville, Joinville, Brazil., Diegoli H; Stroke Neurology Division, Hospital Municipal de Joinville, Joinville, Brazil., Safanelli J; Stroke Neurology Division, Hospital Municipal de Joinville, Joinville, Brazil., André Silveira Salvetti T; Administration Department, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., de Sousa Mendes Parente B; Department of Neurosurgery, 283325Hospital de Base do Distrito Federal, Brasilia, Brazil., Eli Frudit M; Department of Interventional Neuroradiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil., Silva GS; Department of Neurology and Neurosurgery, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil., Pontes-Neto OM; Stroke Service Neurology Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil., Nogueira RG; Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA.
Jazyk:	angličtina
Zdroj:	International journal of stroke : official journal of the International Stroke Society [Int J Stroke] 2021 Nov 03, pp. 17474930211055932. Date of Electronic Publication: 2021 Nov 03.
DOI:	10.1177/17474930211055932
Abstrakt:	Background: The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil. Aims: This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective. Methods: A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results. Results: The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold. Conclusions: The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.
Databáze:	MEDLINE
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