Abstract：
BACKGROUND: Recent studies, including the TENSION trial, support the use of endovascular thrombectomy (EVT) in acute ischemic stroke with large infarct (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 3-5).
OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective.
METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties.
RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups.
CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.
OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective.
METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties.
RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups.
CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.
摘要：
背景：最近的研究，包括紧张审判，支持在伴有大面积梗死的急性缺血性卒中中中使用血管内血栓切除术(EVT)(Alberta卒中计划早期计算机断层扫描评分(ASPECTS)3-5).
目的：从德国医疗保健支付者的角度评估EVT与仅在该人群中的最佳医疗保健（BMC）的成本效益。
方法：使用短期决策树和长期马尔可夫模型（生命周期）来比较EVT和BMC之间的医疗保健成本和质量调整生命年（QALYs）。EVT的有效性由TENSION试验的90天改良Rankin量表（mRS）结果反映。QALY基于已发布的mRS特定卫生实用程序（EQ-5D-3L指数）。长期医疗费用是根据保险数据计算的。成本（以2022欧元报告）和QALY每年折扣3%。使用增量成本效益比（ICER）评估成本效益。进行确定性和概率敏感性分析以考虑参数不确定性。
结果：与BMC相比，EVT产生了更高的终身增量成本(€24257)和效果(1.41QALYs)，导致ICER为17158欧元/QALY。结果对敏感性分析中的参数变化是稳健的(例如，在愿意支付>22000欧元/QALY的情况下，实现了95%的成本效益概率)。亚组分析表明，所有ASPECTS亚组的EVT均具有成本效益。
结论：与BMC相比，EVT对于已确定的大面积梗死的急性缺血性卒中可能具有成本效益。假设医疗保健付款人认为额外投资17158欧元/QALY是可以接受的。
目的：从德国医疗保健支付者的角度评估EVT与仅在该人群中的最佳医疗保健（BMC）的成本效益。
方法：使用短期决策树和长期马尔可夫模型（生命周期）来比较EVT和BMC之间的医疗保健成本和质量调整生命年（QALYs）。EVT的有效性由TENSION试验的90天改良Rankin量表（mRS）结果反映。QALY基于已发布的mRS特定卫生实用程序（EQ-5D-3L指数）。长期医疗费用是根据保险数据计算的。成本（以2022欧元报告）和QALY每年折扣3%。使用增量成本效益比（ICER）评估成本效益。进行确定性和概率敏感性分析以考虑参数不确定性。
结果：与BMC相比，EVT产生了更高的终身增量成本(€24257)和效果(1.41QALYs)，导致ICER为17158欧元/QALY。结果对敏感性分析中的参数变化是稳健的(例如，在愿意支付>22000欧元/QALY的情况下，实现了95%的成本效益概率)。亚组分析表明，所有ASPECTS亚组的EVT均具有成本效益。
结论：与BMC相比，EVT对于已确定的大面积梗死的急性缺血性卒中可能具有成本效益。假设医疗保健付款人认为额外投资17158欧元/QALY是可以接受的。
