Department of Neurology, University of Rochester, 601 Elmwood Ave., Box 681, Rochester, NY 14642, USA.
Neurology. 2010 Nov 9;75(19):1678-85. doi: 10.1212/WNL.0b013e3181fc2838. Epub 2010 Oct 6.
Multimodal CT, including noncontrast CT (NCCT), CT with contrast, CT angiography (CTA), and perfusion CT (CTP), is increasingly used in acute stroke patients to identify candidates for endovascular therapy. Our goal is to explore the cost-effectiveness of multimodal CT as a diagnostic test.
A Markov model compared multimodal CT to NCCT in a hypothetical cohort of nonhemorrhagic stroke patients presenting within 3 hours of symptom onset who were potential IV tPA candidates. Patients who failed to improve after IV tPA or in whom IV tPA was contraindicated were candidates for endovascular therapy. Direct costs (2008 USD), outcomes, and probabilities were obtained from the literature.
For the 3-month time horizon, multimodal CT had lower costs (-$1,716), had greater quality-adjusted life-years (QALYs, 0.004), and was the cost-effective choice 100% of the time for a willingness-to-pay of $100,000/QALY (probabilistic sensitivity analysis). The number needed to screen with multimodal CT to avoid 1 diagnostic angiogram was 2. Over a lifetime, multimodal CT had lower costs (-$2,058), had greater QALYs (0.008), and was cost-effective, with a 90.1% likelihood, for a willingness-to-pay of $100,000/QALY.
Multimodal CT appears to be a cost-saving screening tool over the short term. However, additional data regarding clinical outcomes following multimodal CT-guided intra-arterial treatment are needed before the long-term cost-effectiveness can be suitably addressed. This analysis can be incorporated into future discussions of multimodal CT as a diagnostic test for unselected patients, within and beyond the 3-hour IV tPA time window.
多模态 CT，包括非增强 CT（NCCT）、增强 CT、CT 血管造影（CTA）和灌注 CT（CTP），越来越多地用于急性脑卒中患者以确定血管内治疗的候选者。我们的目标是探讨多模态 CT 作为诊断试验的成本效益。
一个马尔可夫模型将多模态 CT 与 3 小时内发病的非出血性脑卒中患者的 NCCT 进行了比较，这些患者有可能是 IV tPA 的候选者。那些在 IV tPA 后没有改善或 IV tPA 禁忌的患者是血管内治疗的候选者。直接成本（2008 年美元）、结果和概率来自文献。
在 3 个月的时间范围内，多模态 CT 的成本较低（-1716 美元），质量调整生命年（QALY）较高（0.004），并且在 100000 美元/QALY 的支付意愿下，100%的时间都是具有成本效益的（概率敏感性分析）。用多模态 CT 进行筛查以避免 1 次诊断性血管造影的人数需要 2 人。在一生中，多模态 CT 的成本较低（-2058 美元），QALY 较高（0.008），并且在 100000 美元/QALY 的支付意愿下，有 90.1%的可能性具有成本效益。
多模态 CT 在短期内似乎是一种节省成本的筛查工具。然而，在适当解决长期成本效益之前，需要更多关于多模态 CT 引导的动脉内治疗后临床结果的数据。该分析可以纳入未来对多模态 CT 作为未选择患者的诊断测试的讨论，无论是在 3 小时 IV tPA 时间窗内还是之外。
