Sofia Boudour1, Marine Barral2,3, Benjamin Gory4,5, Caroline Giroudon6, Gilles Aulagner1, Anne-Marie Schott2,3, Francis Turjman7, Marie Viprey2,3, Xavier Armoiry8,9. 1. Hospices Civils de Lyon, UMR-CNRS 5510, MATEIS, Bron, France. 2. Pôle IMER, Hospices Civils de Lyon, 69003, Lyon, France. 3. HESPER EA 7425, University of Lyon, University Claude Bernard Lyon 1, 69008, Lyon, France. 4. Department of Diagnostic and Interventional Neuroradiology, University Hospital of Nancy, Nancy, France. 5. Laboratory of Diagnostic and Interventional Adaptative Imaging (IADI), INSERM U947, University of Lorraine, University Hospital of Nancy, Nancy, France. 6. Central Documentation Department, Hospices Civils de Lyon, Lyon, France. 7. Department of Interventional Neuroradiology, FHU IRIS, Hospices Civils de Lyon, Neurologic Hospital Pierre Wertheimer, Bron, France. 8. Hospices Civils de Lyon, UMR-CNRS 5510, MATEIS, Bron, France. armoiryxa@gmail.com. 9. Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV47AL, England, UK. armoiryxa@gmail.com.
Abstract
BACKGROUND: Our objective was to review economic evaluations on stent-retriever thrombectomy (SRT) added/not added to intravenous (IV) tissue plasminogen activator (t-PA) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). METHODS: We conducted a systematic review using several electronic databases and searching for studies published from January 2009 to September 2017. INCLUSION CRITERIA: any publication type reporting the incremental cost-effectiveness ratio of SRT in people with AIS secondary to LVO. Quality assessment was undertaken with the CHEERS and the Philips' checklists. RESULTS: Eight original articles (four from North America/four from Europe) were included; of these, seven were model-based cost-effectiveness studies and one was a study conducted alongside a clinical trial. The perspective was the healthcare system in seven studies, and societal in one. The time horizon was lifetime (minimum 20 years) in all but two studies where it was 1 and 5 years. Overall, studies were rated of good quality (mean score 79%; range 70-90). Data sources, effectiveness outcomes and other input parameters were heterogeneous across studies. In three studies, SRT was dominant (less expensive and more effective). In five studies, SRT was more expensive and generated more quality-adjusted life years but had a high probability (79-100%) to be cost-effective at conventional thresholds. CONCLUSION: This review shows that SRT added/not added to IV t-PA is likely to be cost-effective or even dominant, which is consistent with the opinion from several Health Technology Assessment bodies recommending SRT. However, our findings are supported by primary studies with substantial methodological heterogeneity.
BACKGROUND: Our objective was to review economic evaluations on stent-retriever thrombectomy (SRT) added/not added to intravenous (IV) tissue plasminogen activator (t-PA) in acute ischemic stroke (AIS) due to large-vessel occlusion (LVO). METHODS: We conducted a systematic review using several electronic databases and searching for studies published from January 2009 to September 2017. INCLUSION CRITERIA: any publication type reporting the incremental cost-effectiveness ratio of SRT in people with AIS secondary to LVO. Quality assessment was undertaken with the CHEERS and the Philips' checklists. RESULTS: Eight original articles (four from North America/four from Europe) were included; of these, seven were model-based cost-effectiveness studies and one was a study conducted alongside a clinical trial. The perspective was the healthcare system in seven studies, and societal in one. The time horizon was lifetime (minimum 20 years) in all but two studies where it was 1 and 5 years. Overall, studies were rated of good quality (mean score 79%; range 70-90). Data sources, effectiveness outcomes and other input parameters were heterogeneous across studies. In three studies, SRT was dominant (less expensive and more effective). In five studies, SRT was more expensive and generated more quality-adjusted life years but had a high probability (79-100%) to be cost-effective at conventional thresholds. CONCLUSION: This review shows that SRT added/not added to IV t-PA is likely to be cost-effective or even dominant, which is consistent with the opinion from several Health Technology Assessment bodies recommending SRT. However, our findings are supported by primary studies with substantial methodological heterogeneity.
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