Yvo B Roos1, Marcel G W Dijkgraaf2, Lucie A van den Berg1, Olvert A Berkhemer3,4,5,6, Puck S S Fransen4, Debbie Beumer7, Hester Lingsma8, Charles B M Majoie3, Diederik W J Dippel4, Aad van der Lugt5, Robert J van Oostenbrugge7, Wim H van Zwam6. 1. Departments of Neurology (L.A.v.d.B., Y.B.R.). 2. Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.). 3. Radiology and Nuclear Medicine (C.B.M.M., O.A.B.), Amsterdam University Medical Center, the Netherlands. 4. Departments of Neurology (O.A.B., P.S.S.F., D.W.J.D.), Erasmus MC University Medical Center Rotterdam, the Netherlands. 5. Radiology (O.A.B., A.v.d.L.), Erasmus MC University Medical Center Rotterdam, the Netherlands. 6. Radiology (O.A.B., W.H.v.Z.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. 7. Departments of Neurology (D.B., R.J.v.O.), Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, the Netherlands. 8. Public Health (H.L.), Erasmus MC University Medical Center Rotterdam, the Netherlands.
Abstract
BACKGROUND AND PURPOSE: Endovascular treatment for acute ischemic stroke has been proven clinically effective, but evidence of the cost-effectiveness based on real-world data is scarce. The aim of this study was to assess whether endovascular therapy plus usual care is cost-effective in comparison to usual care alone in acute ischemic stroke patients. METHODS: An economic evaluation was performed from a societal perspective with a 2-year time horizon. Empirical data on health outcomes and the use of resources following endovascular treatment were gathered parallel to the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and its 2-year follow-up study. Incremental cost-effectiveness ratios were calculated as the extra costs per additional patient with functional independence (modified Rankin Scale score 0-2) and the extra cost per quality-adjusted life year gained. RESULTS: The mean costs per patient in the intervention group were $126 494 versus $143 331 in the control group (mean difference, -$16 839 [95% CI, -$38 113 to $5456]). Compared with patients in the control group, more patients in the intervention group achieved functional independence, 37.2% versus 23.9% (absolute difference, 13.3% [95% CI, 4.0%-22.0%]) and they generated more quality-adjusted life years, 0.99 versus 0.83 (mean difference of 0.16 [95% CI, 0.04-0.29]). Endovascular treatment dominated standard treatment with $18 233 saved per extra patient with a good outcome and $105 869 saved per additional quality-adjusted life year. CONCLUSIONS: Endovascular treatment added to usual care is clinically effective, and cost saving in comparison to usual care alone in patients with acute ischemic stroke. Registration: URL: https://www.trialregister.nl/trial/695; Unique identifier: NL695. URL: https://www.isrctn.com; Unique identifier: ISRCTN10888758.
BACKGROUND AND PURPOSE: Endovascular treatment for acute ischemic stroke has been proven clinically effective, but evidence of the cost-effectiveness based on real-world data is scarce. The aim of this study was to assess whether endovascular therapy plus usual care is cost-effective in comparison to usual care alone in acute ischemic stroke patients. METHODS: An economic evaluation was performed from a societal perspective with a 2-year time horizon. Empirical data on health outcomes and the use of resources following endovascular treatment were gathered parallel to the MR CLEAN trial (Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands) and its 2-year follow-up study. Incremental cost-effectiveness ratios were calculated as the extra costs per additional patient with functional independence (modified Rankin Scale score 0-2) and the extra cost per quality-adjusted life year gained. RESULTS: The mean costs per patient in the intervention group were $126 494 versus $143 331 in the control group (mean difference, -$16 839 [95% CI, -$38 113 to $5456]). Compared with patients in the control group, more patients in the intervention group achieved functional independence, 37.2% versus 23.9% (absolute difference, 13.3% [95% CI, 4.0%-22.0%]) and they generated more quality-adjusted life years, 0.99 versus 0.83 (mean difference of 0.16 [95% CI, 0.04-0.29]). Endovascular treatment dominated standard treatment with $18 233 saved per extra patient with a good outcome and $105 869 saved per additional quality-adjusted life year. CONCLUSIONS: Endovascular treatment added to usual care is clinically effective, and cost saving in comparison to usual care alone in patients with acute ischemic stroke. Registration: URL: https://www.trialregister.nl/trial/695; Unique identifier: NL695. URL: https://www.isrctn.com; Unique identifier: ISRCTN10888758.
Entities:
Keywords:
cost savings; follow-up studies; ischemic stroke; quality-adjusted life years
Authors: Miou S Koopman; Jan W Hoving; Henk van Voorst; Jasper D Daems; Daan Peerlings; Erik Buskens; Hester F Lingsma; Henk A Marquering; Hugo Wam de Jong; Olvert A Berkhemer; Wim H van Zwam; Marianne Aa van Walderveen; Ido van den Wijngaard; Aad van der Lugt; Diederik Wj Dippel; Albert J Yoo; Bruce Cv Campbell; Wolfgang G Kunz; Charles Blm Majoie; Bart J Emmer Journal: Eur Stroke J Date: 2022-04-21