Centre for Evidence-Based Medicine, Oxford, UK and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
Newcastle University, Newcastle upon Tyne, UK.
Clin Med (Lond). 2020 May;20(3):e40-e45. doi: 10.7861/clinmed.2019-0413.
The clinical efficacy and cost-effectiveness of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke is well established, but uncertainty remains around the true cost of delivering this treatment within the NHS. The aim of this study was to establish the cost of providing MT within the hyperacute phase of care and to explore differences in resources used and costs across different neuroscience centres in the UK.
This was a multicentre retrospective study using micro-costing methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018.
Data were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527-11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649-8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381-1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345-2,719; p<0001).The mean cost within 72 hours was £12,440 (95% CI 10,628-14,252). The total costs for the duration of inpatient care before discharge from a thrombectomy centre was £14,362 (95% CI 13,603-15,122).
Major factors contributing to costs of MT for stroke include consumables and staff for intervention, use of general anaesthesia and ICU admissions. These findings can inform the reimbursement, provision and strategic planning of stroke services and aid future economic evaluations.
机械取栓（MT）治疗大血管闭塞性卒中的临床疗效和成本效益已得到充分证实，但在 NHS 内提供这种治疗的真实成本仍存在不确定性。本研究旨在确定在超急性期内提供 MT 的成本，并探讨英国不同神经科学中心之间资源使用和成本的差异。
这是一项多中心回顾性研究，采用微观成本法准确评估 NHS 视角下 MT 的成本。2015 年至 2018 年间，从英国的五家神经科学中心收集了 310 名接受 MT 治疗的急性缺血性卒中患者的数据。使用资源及其成本的数据。
共收集了 310 例接受 MT 治疗的急性缺血性卒中患者的数据。每例患者在 24 小时内提供 MT 和住院治疗的平均总成本为 10846 英镑（95%置信区间[CI] 10527-11165）。成本的主要驱动因素是 MT 手术成本，占 24 小时总成本的 73%（7943 英镑；95%CI 7649-8237）。全身麻醉（11048 英镑；标准差[SD] 2654）比局部麻醉（9978 英镑；SD 2654）的患者成本更高，平均差异为 1070 英镑（95%CI 381-1759；p=0.003）；入住重症监护病房（ICU；12212 英镑；SD 3028）与入住其他病房（10179 英镑；SD 2415）的患者相比，平均差异为 2032 英镑（95%CI 1345-2719；p<0001）。72 小时内的平均费用为 12440 英镑（95%CI 10628-14252）。从血栓切除术中心出院前住院治疗的总费用为 14362 英镑（95%CI 13603-15122）。
导致 MT 治疗卒中成本的主要因素包括干预的耗材和人员、全身麻醉的使用以及 ICU 入院。这些发现可以为卒中服务的报销、提供和战略规划提供信息，并有助于未来的经济评估。
