Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset

Autor: Alexander Konnopka, Louisa-Kristin Muntendorf, Jochen B. Fiebach, Norbert Nighoghossian, Keith W. Muir, Matthias Endres, Hans-Helmut König, Florent Boutitie, Vincent Thijs, Claus Z Simonsen, Götz Thomalla, Salvador Pedraza, Christian Gerloff, Robin Lemmens, Martin Ebinger
Přispěvatelé: CarMeN, laboratoire, Universitaetsklinikum Hamburg-Eppendorf = University Medical Center Hamburg-Eppendorf [Hamburg] (UKE), Hospices Civils de Lyon (HCL), Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Klinik für Neurologie, Westfälische Wilhelms-Universität Münster = University of Münster (WWU), German Research Center for Neurodegenerative Diseases - Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany, Austin Health, University of Melbourne, The Florey Institute of Neuroscience and Mental Health, University Hospitals Leuven [Leuven], Catholic University of Leuven - Katholieke Universiteit Leuven (KU Leuven), University of Glasgow, Cardiovasculaire, métabolisme, diabétologie et nutrition (CarMeN), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Hospices Civils de Lyon (HCL)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Institut d'Investigació Biomèdica de Girona Dr. Josep Trueta - Girona Biomedical Research Institute (IDIBGI), Aarhus University Hospital
Rok vydání: 2021
Předmět:
thrombolysis
medicine.medical_specialty
Cost effectiveness
[SDV]Life Sciences [q-bio]
Cost-Benefit Analysis
medicine.medical_treatment
Placebo
law.invention
methods [Magnetic Resonance Imaging]
Randomized controlled trial
Modified Rankin Scale
law
economics [Thrombolytic Therapy]
Acute care
economics [Magnetic Resonance Imaging]
medicine
magnetic resonance imaging
Humans
methods [Cost-Benefit Analysis]
Thrombolytic Therapy
ddc:610
cost-effectiveness
Stroke
quality-adjusted life-year
tissue-type plasminogen activator
health care economics and organizations
business.industry
Health Policy
Public Health
Environmental and Occupational Health
methods [Thrombolytic Therapy]
Thrombolysis
medicine.disease
Magnetic Resonance Imaging
Markov Chains
Quality-adjusted life year
[SDV] Life Sciences [q-bio]
Surgery
Computer-Assisted
Emergency medicine
Quality-Adjusted Life Years
business
Zdroj: Value in health 24(11), 1620-1627 (2021). doi:10.1016/j.jval.2021.05.005
Value in Health
Value in Health, 2021, 24 (11), pp.1620-1627. ⟨10.1016/j.jval.2021.05.005⟩
Muntendorf, L K, Konnopka, A, König, H H, Boutitie, F, Ebinger, M, Endres, M, Fiebach, J B, Thijs, V, Lemmens, R, Muir, K W, Nighoghossian, N, Pedraza, S, Simonsen, C Z, Gerloff, C & Thomalla, G 2021, ' Cost-Effectiveness of Magnetic Resonance Imaging-Guided Thrombolysis for Patients With Stroke With Unknown Time of Onset ', Value in Health, vol. 24, no. 11, pp. 1620-1627 . https://doi.org/10.1016/j.jval.2021.05.005
ISSN: 1098-3015
1524-4733
DOI: 10.1016/j.jval.2021.05.005
Popis: International audience; OBJECTIVES: Patients waking up with stroke symptoms are often excluded from intravenous thrombolysis with alteplase (IV-tpa). The WAKE-UP trial, a European multicenter randomized controlled trial, proved the clinical effectiveness of magnetic resonance imaging-guided IV-tpa for these patients. This analysis aimed to assess the cost-effectiveness of the intervention compared to placebo. METHODS: A Markov model was designed to analyze the cost-effectiveness over a 25-year time horizon. The model consisted of an inpatient acute care phase and a rest-of-life phase. Health states were defined by the modified Rankin Scale (mRS). Initial transition probabilities to mRS scores were based on WAKE-UP data and health state utilities on literature search. Costs were based on data from the University Medical Center Hamburg-Eppendorf, literature, and expert opinion. Incremental costs and effects over the patients' lifetime were estimated. The analysis was conducted from a formal German healthcare perspective. Univariate and probabilistic sensitivity analyses were performed. RESULTS: Treatment with IV-tpa resulted in cost savings of €51 009 and 1.30 incremental gains in quality-adjusted life-years at a 5% discount rate. Univariate sensitivity analysis revealed incremental cost-effectiveness ratio being sensitive to the relative risk of favorable outcome on mRS for placebo patients after stroke, the costs of long-term care for patients with mRS 4, and patient age at initial stroke event. In all cases, IV-tpa remained cost-effective. Probabilistic sensitivity analysis proved IV-tpa cost-effective in \textgreater95% of the simulations results. CONCLUSIONS: Magnetic resonance imaging-guided IV-tpa compared to placebo is cost-effective in patients with ischemic stroke with unknown time of onset.
Databáze: OpenAIRE
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