Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA.
University of Washington School of Medicine, Seattle, Washington, USA.
J Neurointerv Surg. 2021 Sep;13(9):784-789. doi: 10.1136/neurintsurg-2020-016765. Epub 2020 Oct 19.
The cost-effectiveness of endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to M2 branch occlusion remains uncertain.
To evaluate the cost-effectiveness of EVT compared with medical management in patients with acute stroke presenting with M2 occlusion using a decision-analytic model.
A decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years and associated costs of EVT-treated patients compared with no-EVT/medical management. The study was performed over a lifetime horizon with a societal perspective in the Unites States setting. Base case, one-way, two-way, and probabilistic sensitivity analyses were performed.
EVT was the long-term cost-effective strategy in 93.37% of the iterations in the probabilistic sensitivity analysis, and resulted in difference in health benefit of 1.66 QALYs in the 65-year-old age groups, equivalent to 606 days in perfect health. Varying the outcomes after both strategies shows that EVT was more cost-effective when the probability of good outcome after EVT was only 4-6% higher relative to medical management in clinically likely scenarios. EVT remained cost-effective even when its cost exceeded US$200 000 (threshold was US$209 111). EVT was even more cost-effective for 55-year-olds than for 65-year-old patients.
Our study suggests that EVT is cost-effective for treatment of acute M2 branch occlusions. Faster and improved reperfusion techniques would increase the relative cost-effectiveness of EVT even further in these patients.
急性缺血性脑卒中患者 M2 分支闭塞的血管内血栓切除术（EVT）的成本效益仍不确定。
使用决策分析模型评估 EVT 与急性脑卒中患者 M2 闭塞的药物治疗相比的成本效益。
进行决策分析研究，使用马尔可夫模型估计 EVT 治疗组与非 EVT/药物治疗组相比的终生质量调整生命年和相关成本。研究在终生范围内进行，从美国社会的角度进行。进行了基础案例、单向、双向和概率敏感性分析。
在概率敏感性分析的 93.37%的迭代中，EVT 是长期成本效益策略，在 65 岁年龄组中健康获益差异为 1.66 QALYs，相当于完全健康的 606 天。两种策略的结果变化表明，在临床可能的情况下，EVT 的疗效比药物治疗仅高出 4-6%，EVT 更具成本效益。即使 EVT 的成本超过 20 万美元（阈值为 209111 美元），EVT 仍然具有成本效益。EVT 对 55 岁患者比 65 岁患者更具成本效益。
我们的研究表明，EVT 治疗急性 M2 分支闭塞是具有成本效益的。更快和改进的再灌注技术将进一步提高这些患者 EVT 的相对成本效益。
