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

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. - Materia...

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Main Authors: Mehrens, Dirk (Author) , Fabritius, Matthias P. (Author) , Reidler, Paul (Author) , Liebig, Thomas (Author) , Afat, Saif (Author) , Ospel, Johanna Maria (Author) , Froelich, Matthias F. (Author) , Schwarting, Julian (Author) , Ricke, Jens (Author) , Dimitriadis, Konstantinos (Author) , Goyal, Mayank (Author) , Kunz, Wolfgang Gerhard (Author)
Format: Article (Journal)
Language:English
Published: March 2024
In: European stroke journal
Year: 2024, Volume: 9, Issue: 1, Pages: 97-104
ISSN:2396-9881
DOI:10.1177/23969873231209616
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873231209616
Verlag, kostenfrei, Volltext: https://journals.sagepub.com/doi/10.1177/23969873231209616
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Author Notes:Dirk Mehrens, Matthias P Fabritius, Paul Reidler, Thomas Liebig, Saif Afat, Johanna M Ospel, Matthias F Fröhlich, Julian Schwarting, Jens Ricke, Konstantinos Dimitriadis, Mayank Goyal and Wolfgang G Kunz
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Summary: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.
Item Description:Online veröffentlicht: 31. Oktober 2023
Gesehen am 07.03.2024
Physical Description:Online Resource
ISSN:2396-9881
DOI:10.1177/23969873231209616

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