Abstract | OBJECT: METHODS: Clinical outcomes of an open-label study of mechanical thrombectomy were compared with a hypothetical control group with a lower recanalization rate (18 vs 60%) and a lower rate of symptomatic intracranial hemorrhage (0.6 vs 7.8%) than the active treatment group. A Markov cost-effectiveness model was built to compare the health benefits and costs associated with mechanical thrombectomy compared with standard medical therapy. All probabilities, quality-of-life factors, and costs were estimated from the published literature. Univariate sensitivity analyses were performed to assess how variations in model parameters affect health and economic outcomes. RESULTS: Treatment of acute ischemic stroke with mechanical thrombectomy increased survival time by 0.54 quality-adjusted life years (QALYs), compared with standard medical therapy (2.37 vs 1.83 QALYs), at an increased cost of $6600. This yielded an incremental cost-effectiveness ratio (ICER) of $12,120 per QALY gained, a value generally considered cost-effective. Sensitivity analysis showed that mechanical thrombectomy remained cost-effective (ICER < $50,000 per QALY gained) for all model inputs varied over a reasonable range, except for age at stroke treatment. For patients older than 82 years of age, the treatment was only borderline cost-effective (ICER of $50,000-100,000 per QALY gained). CONCLUSIONS: The treatment of large-vessel ischemic stroke with mechanical thrombectomy appears to be costeffective. These results require validation when data from a randomized, controlled trial of mechanical thrombectomy become available.
|
Authors | Chirag G Patil, Elisa F Long, Maarten G Lansberg |
Journal | Journal of neurosurgery
(J Neurosurg)
Vol. 110
Issue 3
Pg. 508-13
(Mar 2009)
ISSN: 0022-3085 [Print] United States |
PMID | 19025358
(Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural)
|
Topics |
- Aged, 80 and over
- Brain Ischemia
(complications)
- Cost-Benefit Analysis
- Decision Trees
- Humans
- Middle Aged
- Quality of Life
- Stroke
(drug therapy, surgery)
- Thrombectomy
(economics)
|