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.

Autor: van Voorst H; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. h.vanvoorst@amsterdamumc.nl.; Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands. h.vanvoorst@amsterdamumc.nl., Hoving JW; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands., Koopman MS; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands., Daems JD; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands.; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands., Peerlings D; Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands., Buskens E; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands., Lingsma HF; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands., Beenen LFM; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands., de Jong HWAM; Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands., Berkhemer OA; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.; Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.; Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands., van Zwam WH; Department of Radiology and Nuclear Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, the Netherlands., Roos YBWEM; Department of Neurology, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands., van Walderveen MAA; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands., van den Wijngaard I; Department of Neurology, Haaglanden Medical Center, The Hague, the Netherlands., Dippel DWJ; Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands., Yoo AJ; Department of Radiology, Texas Stroke Institute, Dallas-Fort Worth, TX, USA., Campbell BCV; Department of Medicine and Neurology, Melbourne Brain Center, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia., Kunz WG; Department of Radiology, University Hospital, LMU Munich, Munich, Germany., Emmer BJ; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands., Majoie CBLM; Department of Radiology and Nuclear Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
Jazyk: angličtina
Zdroj: European radiology [Eur Radiol] 2024 Apr; Vol. 34 (4), pp. 2152-2167. Date of Electronic Publication: 2023 Sep 20.
DOI: 10.1007/s00330-023-10119-y
Abstrakt: 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.
(© 2023. The Author(s).)
Databáze: MEDLINE
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