Pan Yuesong, Cai Xueli, Huo Xiaochuan, Zhao Xingquan, Liu Liping, Wang Yongjun, Miao Zhongrong, Wang Yilong
Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
China National Clinical Research Centre for Neurological Diseases, Beijing, China.
BMJ Open. 2018 Feb 22;8(2):e018951. doi: 10.1136/bmjopen-2017-018951.
Endovascular mechanical thrombectomy is an effective but expensive therapy for acute ischaemic stroke with proximal anterior circulation occlusion. This study aimed to determine the cost-effectiveness of mechanical thrombectomy in China, which is the largest developing country.
A combination of decision tree and Markov model was developed. Outcome and cost data were derived from the published literature and claims database. The efficacy data were derived from the meta-analyses of nine trials. One-way and probabilistic sensitivity analyses were performed in order to assess the uncertainty of the results.
Hospitals in China.
The patients with acute ischaemic stroke caused by proximal anterior circulation occlusion within 6 hours.
Mechanical thrombectomy within 6 hours with intravenous tissue plasminogen activator (tPA) treatment within 4.5 hours versus intravenous tPA treatment alone.
The benefit conferred by the treatment was assessed by estimating the cost per quality-adjusted life-year (QALY) gained in the long term (30 years).
The addition of mechanical thrombectomy to intravenous tPA treatment compared with standard treatment alone yielded a lifetime gain of 0.794 QALYs at an additional cost of CNY 50 000 (US$7700), resulting in a cost of CNY 63 010 (US$9690) per QALY gained. The probabilistic sensitivity analysis indicated that mechanical thrombectomy was cost-effective in 99.9% of the simulation runs at a willingness-to-pay threshold of CNY 125 700 (US$19 300) per QALY.
Mechanical thrombectomy for acute ischaemic stroke caused by proximal anterior circulation occlusion within 6 hours was cost-effective in China. The data may be used as a reference with regard to medical resources allocation for stroke treatment in low-income and middle-income countries as well as in the remote areas in the developed countries.
血管内机械取栓术是治疗伴有近端前循环闭塞的急性缺血性卒中的一种有效但昂贵的疗法。本研究旨在确定在中国这个最大的发展中国家，机械取栓术的成本效益。
构建决策树和马尔可夫模型相结合的模型。结局和成本数据来源于已发表的文献和索赔数据库。疗效数据来源于9项试验的荟萃分析。进行单向和概率敏感性分析以评估结果的不确定性。
中国的医院。
6小时内由近端前循环闭塞导致急性缺血性卒中的患者。
6小时内行机械取栓术并在4.5小时内行静脉注射组织型纤溶酶原激活剂（tPA）治疗，与单纯静脉注射tPA治疗对比。
通过估算长期（30年）每获得一个质量调整生命年（QALY）的成本来评估治疗带来的益处。
与单纯标准治疗相比，在静脉注射tPA治疗基础上加用机械取栓术可使终生获得0.794个QALY，额外成本为50000元人民币（7700美元），即每获得一个QALY的成本为63010元人民币（9690美元）。概率敏感性分析表明，在支付意愿阈值为每QALY 125700元人民币（19300美元）时，机械取栓术在99.9%的模拟运行中具有成本效益。
在中国，6小时内对由近端前循环闭塞导致的急性缺血性卒中进行机械取栓术具有成本效益。这些数据可作为低收入和中等收入国家以及发达国家偏远地区卒中治疗医疗资源分配的参考。
