Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands
Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
J Neurointerv Surg. 2021 Dec;13(12):1099-1105. doi: 10.1136/neurintsurg-2020-017017. Epub 2021 Jan 21.
The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population.
A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs.
EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: -65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs.
One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.
血管内治疗（EVT）治疗大动脉闭塞（LVO）卒中的效果严重依赖于治疗时间。然而，在指数卒中后，治疗时间更快的价值尚不清楚。本研究的目的是量化在荷兰 LVO 卒中人群中，EVT 更快治疗在健康和医疗保健成本方面的价值。
使用马尔可夫模型模拟 69 岁 LVO 患者的 5 年随访功能结局，采用改良 Rankin 量表（mRS）进行测量。治疗后 mRS 从 MR CLEAN 登记处（n=2892）中提取：从 MR CLEAN 试验（n=500）的随访数据中获取单位时间成本和每个 mRS 亚量表的质量调整生命年（QALY）。以支付意愿为 80000 欧元/QALY 为基准报告净货币效益（NMB）作为主要结果，其次是无残疾生活天数和成本。
EVT 每提前 1 分钟治疗，中位数 NMB 为 309 欧元（IQR：226；389），额外的无残疾生活天数为 1.3 天（IQR：1.0；1.6），而在 5 年的随访期间，累积成本基本保持不变（中位数：-15 欧元，IQR：-65；33）。由于在随访期间成本保持稳定，而 QALYs 随着治疗时间的延长而下降，这导致 NMB 呈近线性下降。由于接受更快 EVT 的患者寿命更长，因此他们产生了更多的医疗保健成本。
EVT 每提前一分钟治疗，QALYs 增加，而累积成本基本保持不变。因此，更快的 EVT 在不增加医疗保健成本的情况下提供了更好的护理价值。
