Kyriakos Lobotesis1, Roland Veltkamp2, Isobel H Carpenter3, Lindsay M Claxton3, Jeffrey L Saver4, Robert Hodgson3. 1. a Imperial College Healthcare NHS Trust , London , UK ; 2. b Division of Brain Sciences , Imperial College , London , UK ; 3. c York Health Economics Consortium, University of York , York , UK ; 4. d Department of Neurology and Comprehensive Stroke Center, David Geffen School of Medicine , University of California, Los Angeles (UCLA) , Los Angeles , CA , USA.
Abstract
OBJECTIVE: To evaluate the cost-effectiveness of neurothrombectomy with a stent retriever (Solitaire * Revascularization Device) in treating acute ischemic stroke patients from the UK healthcare provider perspective. METHODS: A Markov model was developed to simulate health outcomes and costs of two therapies over a lifetime time horizon: stent-retriever thrombectomy in combination with intravenous tissue-type plasminogen activator (IV t-PA), and IV t-PA alone. The model incorporated an acute phase (0-90 days) and a rest of life phase (90+ days). Health states were defined by the modified Rankin Scale score. During the rest of life phase, patients remained in the same health state until a recurrent stroke or death. Clinical effectiveness and safety data were taken from the SWIFT PRIME study. Resource use and health state utilities were informed by published data. RESULTS:Combined stent-retriever thrombectomy and IV t-PA led to improved quality-of-life and increased life expectancy compared to IV t-PA alone. The higher treatment costs associated with the use of stent-retriever thrombectomy were offset by long-term cost savings due to improved patient health status, leading to overall cost savings of £33 190 per patient and a net benefit of £79 402. Deterministic and probabilistic sensitivity analyses demonstrated that the results were robust to a wide range of parameter inputs. LIMITATIONS: The acute and long-term costs resource use data were taken from a study based on a patient population that was older and may have had additional comorbidities than the SWIFT PRIME population, resulting in costs that may not be representative of the cohort within this model. In addition, the estimates may not reflect stroke care today as no current evidence is available; however, the cost estimates were deemed reasonable by clinical opinion. CONCLUSIONS:Combined stent-retriever neurothrombectomy and IV t-PA is a cost-effective treatment for acute ischemic stroke compared with IV t-PA alone.
RCT Entities:
OBJECTIVE: To evaluate the cost-effectiveness of neurothrombectomy with a stent retriever (Solitaire * Revascularization Device) in treating acute ischemic strokepatients from the UK healthcare provider perspective. METHODS: A Markov model was developed to simulate health outcomes and costs of two therapies over a lifetime time horizon: stent-retriever thrombectomy in combination with intravenous tissue-type plasminogen activator (IV t-PA), and IV t-PA alone. The model incorporated an acute phase (0-90 days) and a rest of life phase (90+ days). Health states were defined by the modified Rankin Scale score. During the rest of life phase, patients remained in the same health state until a recurrent stroke or death. Clinical effectiveness and safety data were taken from the SWIFT PRIME study. Resource use and health state utilities were informed by published data. RESULTS: Combined stent-retriever thrombectomy and IV t-PA led to improved quality-of-life and increased life expectancy compared to IV t-PA alone. The higher treatment costs associated with the use of stent-retriever thrombectomy were offset by long-term cost savings due to improved patient health status, leading to overall cost savings of £33 190 per patient and a net benefit of £79 402. Deterministic and probabilistic sensitivity analyses demonstrated that the results were robust to a wide range of parameter inputs. LIMITATIONS: The acute and long-term costs resource use data were taken from a study based on a patient population that was older and may have had additional comorbidities than the SWIFT PRIME population, resulting in costs that may not be representative of the cohort within this model. In addition, the estimates may not reflect stroke care today as no current evidence is available; however, the cost estimates were deemed reasonable by clinical opinion. CONCLUSIONS: Combined stent-retriever neurothrombectomy and IV t-PA is a cost-effective treatment for acute ischemic stroke compared with IV t-PA alone.
Authors: Elizabeth Parody-Rua; Alejandro Bustamante; Joan Montaner; Maria Rubio-Valera; David Serrano; Soledad Pérez-Sánchez; Alba Sánchez-Viñas; César Guevara-Cuellar; Antoni Serrano-Blanco Journal: Eur J Health Econ Date: 2022-07-27
Authors: Joyce S Balami; Diamuid Coughlan; Phil M White; Peter McMeekin; Darren Flynn; Christine Roffe; Indira Natarajan; Jayan Chembala; Sanjeev Nayak; Ivan Wiggam; Peter Flynn; Robert Simister; Yazen Sammaraiee; Don Sims; Kurdow Nader; Anand Dixit; Dawn Craig; Hannah Lumley; Stephen Rice; David Burgess; Lisa Foddy; Emer Hopkins; Beverley Hudson; Rachael Jones; Martin A James; Alastair M Buchan; Gary A Ford; Alastair M Gray Journal: Clin Med (Lond) Date: 2020-05 Impact factor: 2.659
Authors: Fernando de Andrés-Nogales; María Álvarez; María Ángeles de Miquel; Tomás Segura; Alberto Gil; Pere Cardona; Miguel Ángel Casado; Raul G Nogueira; Antoni Dávalos Journal: Eur Stroke J Date: 2017-08-01
Authors: Ingrid Lekander; Carl Willers; Mia von Euler; Mikael Lilja; Katharina S Sunnerhagen; Hélène Pessah-Rasmussen; Fredrik Borgström Journal: PLoS One Date: 2017-04-06 Impact factor: 3.240
Authors: Anne-Claire Peultier; William K Redekop; Michael Allen; Jaime Peters; Omer Faruk Eker; Johan L Severens Journal: Stroke Date: 2019-10-22 Impact factor: 7.914