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Real-World Cost-Effectiveness of Late Time Window Thrombectomy for Patients With Ischemic Stroke

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Version 2 2024-06-06, 03:02
Version 1 2022-01-12, 08:31
journal contribution
posted on 2024-06-19, 08:03 authored by Lan GaoLan Gao, A Bivard, M Parsons, NJ Spratt, C Levi, K Butcher, T Kleinig, B Yan, Q Dong, X Cheng, M Lou, C Yin, C Chen, P Wang, L Lin, P Choi, F Miteff, Marj MoodieMarj Moodie
Background: To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for patients with ischemic stroke in the >4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria.Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in patients meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, vs. medical treatment alone (including intravenous thrombolysis). The effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischemic stroke, between 2015 and 2019, in the extended time window (>4.5 h).Results: Endovascular thrombectomy was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort [incremental cost-effectiveness ratio (ICER) of $11,608/quality-adjusted life year (QALY) for DEFUSE 3-postive or $34,416/QALY for DAWN-positive]. However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (−1.02 QALY for DEFUSE 3; −1.43 QALY for DAWN) and higher long-term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), thereby making it unlikely to be cost-effective in Australia.Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.

History

Journal

Frontiers in Neurology

Volume

12

Article number

ARTN 780894

Pagination

1 - 9

Location

Switzerland

Open access

  • Yes

ISSN

1664-2295

eISSN

1664-2295

Language

English

Publication classification

C1 Refereed article in a scholarly journal

Publisher

FRONTIERS MEDIA SA