BACKGROUND AND PURPOSE: Improved selection of patients with stroke for IV tPA treatment may enhance clinical outcomes. Given the limited availability of MR imaging in hospitals, we examined the cost-effectiveness of adding CTP to the usual CT-based methods for selecting patients on the basis of the presence and extent of penumbra. MATERIALS AND METHODS: A decision-analytic model estimated the costs and outcomes associated with penumbra-based CTP selection in a patient population similar to that enrolled in the IV tPA clinical trials. Model inputs were obtained from published literature, clinical trial data, standard US costing sources, and expert opinion. Cost per life-year saved and cost per QALY gained were estimated from a hospital perspective. RESULTS: Addition of penumbra-based CTP to standard unenhanced CT improved favorable outcome (mRS, ≤1) by 0.59% and reduced cost by $42 compared with selection based on unenhanced CT alone. Life-years and QALYs improved. Multivariate sensitivity analysis predicted cost-effectiveness (≤$50,000 per QALY) in 89.2% of simulation runs. CONCLUSIONS: Using penumbra-based CTP after routine CT to select patients with ischemic stroke for IV tPA is cost-effective compared with the usual CT-based methods for hospitals. With the ease of access of CTP, penumbra-based selection methods may be readily available to hospitals. Thus, this economic analysis may lend further support to the consideration of a paradigm shift in acute stroke evaluation.
BACKGROUND AND PURPOSE: Improved selection of patients with stroke for IV tPA treatment may enhance clinical outcomes. Given the limited availability of MR imaging in hospitals, we examined the cost-effectiveness of adding CTP to the usual CT-based methods for selecting patients on the basis of the presence and extent of penumbra. MATERIALS AND METHODS: A decision-analytic model estimated the costs and outcomes associated with penumbra-based CTP selection in a patient population similar to that enrolled in the IV tPA clinical trials. Model inputs were obtained from published literature, clinical trial data, standard US costing sources, and expert opinion. Cost per life-year saved and cost per QALY gained were estimated from a hospital perspective. RESULTS: Addition of penumbra-based CTP to standard unenhanced CT improved favorable outcome (mRS, ≤1) by 0.59% and reduced cost by $42 compared with selection based on unenhanced CT alone. Life-years and QALYs improved. Multivariate sensitivity analysis predicted cost-effectiveness (≤$50,000 per QALY) in 89.2% of simulation runs. CONCLUSIONS: Using penumbra-based CTP after routine CT to select patients with ischemic stroke for IV tPA is cost-effective compared with the usual CT-based methods for hospitals. With the ease of access of CTP, penumbra-based selection methods may be readily available to hospitals. Thus, this economic analysis may lend further support to the consideration of a paradigm shift in acute stroke evaluation.
Authors: Götz Thomalla; Christian Schwark; Jan Sobesky; Erich Bluhmki; Jochen B Fiebach; Jens Fiehler; Olivier Zaro Weber; Thomas Kucinski; Eric Juettler; Peter A Ringleb; Hermann Zeumer; Cornelius Weiller; Werner Hacke; Peter D Schellinger; Joachim Röther Journal: Stroke Date: 2006-01-26 Impact factor: 7.914
Authors: D G Darby; P A Barber; R P Gerraty; P M Desmond; Q Yang; M Parsons; T Li; B M Tress; S M Davis Journal: Stroke Date: 1999-10 Impact factor: 7.914
Authors: Werner Hacke; Markku Kaste; Erich Bluhmki; Miroslav Brozman; Antoni Dávalos; Donata Guidetti; Vincent Larrue; Kennedy R Lees; Zakaria Medeghri; Thomas Machnig; Dietmar Schneider; Rüdiger von Kummer; Nils Wahlgren; Danilo Toni Journal: N Engl J Med Date: 2008-09-25 Impact factor: 91.245
Authors: Werner Hacke; Geoffrey Donnan; Cesare Fieschi; Markku Kaste; Rüdiger von Kummer; Joseph P Broderick; Thomas Brott; Michael Frankel; James C Grotta; E Clarke Haley; Thomas Kwiatkowski; Steven R Levine; Chris Lewandowski; Mei Lu; Patrick Lyden; John R Marler; Suresh Patel; Barbara C Tilley; Gregory Albers; Erich Bluhmki; Manfred Wilhelm; Scott Hamilton Journal: Lancet Date: 2004-03-06 Impact factor: 79.321
Authors: Peter D Schellinger; Götz Thomalla; Jens Fiehler; Martin Köhrmann; Carlos A Molina; Tobias Neumann-Haefelin; Marc Ribo; Oliver C Singer; Olivier Zaro-Weber; Jan Sobesky Journal: Stroke Date: 2007-08-16 Impact factor: 7.914
Authors: Marie Luby; Steven J Warach; Gregory W Albers; Jean-Claude Baron; Christophe Cognard; Antoni Dávalos; Geoffrey A Donnan; Jochen B Fiebach; Jens Fiehler; Werner Hacke; Maarten G Lansberg; David S Liebeskind; Heinrich P Mattle; Catherine Oppenheim; Peter D Schellinger; Joanna M Wardlaw; Max Wintermark Journal: Int J Stroke Date: 2016-02 Impact factor: 5.266
Authors: Kit N Simpson; Annie N Simpson; Patrick D Mauldin; Michael D Hill; Sharon D Yeatts; Judith A Spilker; Lydia D Foster; Pooja Khatri; Renee Martin; Edward C Jauch; Dawn Kleindorfer; Yuko Y Palesch; Joseph P Broderick Journal: Stroke Date: 2014-05-13 Impact factor: 7.914
Authors: Sebastian E Beyer; Myriam G Hunink; Florian Schöberl; Louisa von Baumgarten; Steffen E Petersen; Martin Dichgans; Hendrik Janssen; Birgit Ertl-Wagner; Maximilian F Reiser; Wieland H Sommer Journal: Stroke Date: 2015-05-28 Impact factor: 7.914
Authors: Artem T Boltyenkov; Gabriela Martinez; Ankur Pandya; Jeffrey M Katz; Jason J Wang; Jason J Naidich; Elizabeth Rula; Pina C Sanelli Journal: Front Neurol Date: 2021-11-26 Impact factor: 4.003