Cost-effectiveness of endovascular treatment versus best medical management in basilar artery occlusion stroke: A U.S. healthcare perspective.

Autor:	Mehrens D; Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany., Fabritius MP; Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany., Reidler P; Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany., Liebig T; Institute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany., Afat S; Department of Radiology, University of Tübingen, Tübingen, Germany., Ospel JM; Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.; Department of Radiology, University Hospital of Basel, Basel, Switzerland., Fröhlich MF; Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany., Schwarting J; Department of Diagnostic and Interventional Neuroradiology, Technical University Munich, Munich, Germany., Ricke J; Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany., Dimitriadis K; Institute for Stroke and Dementia Research, LMU University Hospital, LMU Munich, Munich, Germany.; Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany., Goyal M; Departments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada., Kunz WG; Department of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2024 Mar; Vol. 9 (1), pp. 97-104. Date of Electronic Publication: 2023 Oct 31.
DOI:	10.1177/23969873231209616
Abstrakt:	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. Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Databáze:	MEDLINE
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