{Reference Type}: Journal Article
{Title}: Cost-effectiveness of endovascular thrombectomy for acute ischemic stroke with established large infarct in Germany: a decision tree and Markov model.
{Author}: Gottschalk S;König HH;Subtil F;Bonekamp S;Denis A;Aamodt AH;Fuentes B;Gizewski ER;Hill MD;Krajina A;Pierot L;Simonsen CZ;Zeleňák K;Bendszus M;Thomalla G;Dams J;
{Journal}: J Neurointerv Surg
{Volume}: 0
{Issue}: 0
{Year}: 2024 Jun 21
{Factor}: 8.572
{DOI}: 10.1136/jnis-2024-021837
{Abstract}: <B>BACKGROUND: </B>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).<BR><B>OBJECTIVE: </B>To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>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.