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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| Hauptverfasser: | , , , , , , , , , , , |
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| Dokumenttyp: | Article (Journal) |
| Sprache: | Englisch |
| Veröffentlicht: |
March 2024
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| In: |
European stroke journal
Year: 2024, Jahrgang: 9, Heft: 1, Pages: 97-104 |
| ISSN: | 2396-9881 |
| DOI: | 10.1177/23969873231209616 |
| Online-Zugang: | Verlag, kostenfrei, Volltext: https://doi.org/10.1177/23969873231209616 Verlag, kostenfrei, Volltext: https://journals.sagepub.com/doi/10.1177/23969873231209616 
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| Verfasserangaben: | 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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| 245 | 1 | 0 | |a Cost-effectiveness of endovascular treatment versus best medical management in basilar artery occlusion stroke |b a U.S. healthcare perspective: original research article |c 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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| 520 | |a 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. | ||
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