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Reduced Impact of Endovascular Thrombectomy on Disability in Real-World Practice, Relative to Randomized Controlled Trial Evidence in Australia

Gao, Lan, Tan, Elise, Moodie, Marjory, Parsons, M, Spratt, NJ, Levi, C, Butcher, K, Kleinig, T, Yan, B, Chen, C, Lin, L, Choi, P and Bivard, A 2020, Reduced Impact of Endovascular Thrombectomy on Disability in Real-World Practice, Relative to Randomized Controlled Trial Evidence in Australia, Frontiers in Neurology, vol. 11, pp. 1-9, doi: 10.3389/fneur.2020.593238.

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Title Reduced Impact of Endovascular Thrombectomy on Disability in Real-World Practice, Relative to Randomized Controlled Trial Evidence in Australia
Author(s) Gao, LanORCID iD for Gao, Lan orcid.org/0000-0001-9734-1140
Tan, EliseORCID iD for Tan, Elise orcid.org/0000-0002-7640-631X
Moodie, MarjoryORCID iD for Moodie, Marjory orcid.org/0000-0001-6890-5250
Parsons, M
Spratt, NJ
Levi, C
Butcher, K
Kleinig, T
Yan, B
Chen, C
Lin, L
Choi, P
Bivard, A
Journal name Frontiers in Neurology
Volume number 11
Article ID 593238
Start page 1
End page 9
Total pages 9
Publisher Frontiers Media
Place of publication Lausanne, Switzerland
Publication date 2020-12-08
ISSN 1664-2295
1664-2295
Keyword(s) INSPIRE registry
disability adjusted life year (DALY)
randomized controlled clinical trial (RCT)
real-world data analysis
thrombectomy
Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences
Neurosciences & Neurology
ISCHEMIC-STROKE
THERAPY
Summary Background and Aims: Disability-adjusted life years (DALYs) are an important measure of the global burden of disease that informs patient outcomes and policy decision-making. Our study aimed to compare the DALYs saved by endovascular thrombectomy (EVT) in the Australasian-based EXTEND-IA trial vs. clinical registry data from EVT in Australian routine clinical practice.Methods: The 3-month modified Rankin scale (mRS) outcome and treatment status of consecutively enrolled Australian patients with large vessel occlusion (LVO) stroke were taken from the International Stroke Perfusion Imaging Registry (INSPIRE). DALYs were calculated as the summation of years of life lost (YLL) due to premature death and years lived with a disability (YLD). A generalized linear model (GLM) with gamma family and log link was used to compare the difference in DALYs for patients receiving/not receiving EVT while controlling for key covariates. Ordered logit regression model was utilized to compare the difference in functional outcome at 3 months between the treatment groups. Cox regression analysis was undertaken to compare the difference in survival over an 18-year time horizon. Estimated long-term DALYs saved based on the EXTEND-IA randomized controlled trial (RCT) results were used as the comparator.Results: INSPIRE patients who received EVT treatment only achieved nominally better functional outcomes than the non-EVT group (p = 0.181) at 3 months. There was no significant survival gain from EVT over the first 3 months of stroke in both INSPIRE and EXTEND-IA patients. However, measured against no EVT in the long-term, EVT in INSPIRE was associated with no significant survival gain [hazard ratio (HR): 0.92, 95% confidence interval (CI): 0.78–1.08, p = 0.287] compared with the survival benefit extrapolated from the EXTEND-IA trial (HR: 0.42, 95% CI: 0.22–0.82, p = 0.01]. Offering EVT to patients with LVO stroke was also associated with fewer DALYs lost (11.04, 95% CI: 10.45–11.62) than those not receiving EVT in INSPIRE (12.13, 95% CI: 11.75–12.51), a reduction of −1.09 DALY (95% CI: −1.76 to −0.43, p = 0.002). The absolute magnitude of the treatment effect was lower than that seen in EXTEND-IA (−2.72 DALY reduction in EVT vs non-EVT patients).Conclusions: EVT for the treatment of LVO in a registry of routine care was associated with significantly lower DALYs lost than medical care alone, but the saved DALYs are less than those reported in clinical trials, as there were major differences in the baseline characteristics of the patients.
Language eng
DOI 10.3389/fneur.2020.593238
Indigenous content off
Field of Research 1103 Clinical Sciences
1109 Neurosciences
1701 Psychology
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2020 Gao, Tan, Moodie, Parsons, Spratt, Levi, Butcher, Kleinig, Yan, Chen, Lin, Choi and Bivard
Free to Read? Yes
Use Rights Creative Commons Attribution licence
Persistent URL http://hdl.handle.net/10536/DRO/DU:30147005

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Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.