Lenz-Alcayaga Rony, Paredes-Fernández Daniela, Hernández-Sánchez Karla, Valencia-Zapata Juan E
Núcleo Académico Instituto de Salud Pública, Universidad Nacional Andrés Bello, Santiago, Chile; Lenz Consultores, Santiago, Chile. ORCID: 0000-0002-6417-3029.
Núcleo Académico Instituto de Salud Pública, Universidad Nacional Andrés Bello, Santiago, Chile. Email:
Medwave. 2021 Apr 13;21(3):e8152. doi: 10.5867/medwave.2021.03.8152.
Several studies demonstrate the therapeutic superiority of thrombolysis plus mechanical thrombectomy versus thrombolysis alone to treat stroke.
To analyze the cost-utility of thrombolysis plus mechanical thrombectomy versus thrombolysis in patients with ischemic stroke due to large vessel occlusion.
Cost-utility analysis. The model used is blended: Decision Tree (first 90 days) and Markov in the long term, of seven health states based on a disease-specific scale, from the Chilean public insurance and societal perspective. Quality-Adjusted Life-Years and costs are evaluated. Deterministic (DSA) and probabilistic (PSA) analyses were carried out.
From the public insurance perspective, in the base case, mechanical thrombectomy is associated with lower costs in a lifetime horizon, and with higher benefits (2.63 incremental QALYs, and 1.19 discounted incremental life years), at a Net Monetary Benefit (NMB) of CLP 37,289,874, and an Incremental Cost-Utility Ratio (ICUR) of CLP 3,807,413/QALY. For the scenario that incorporates access to rehabilitation, 2.54 incremental QALYs and 1.13 discounted life years were estimated, resulting in an NMB of CLP 35,670,319 and ICUR of CLP 3,960,624/QALY. In the scenario that incorporates access to long-term care from a societal perspective, the ICUR falls to CLP 951,911/QALY, and the NMB raises to CLP 43,318,072, improving the previous scenarios. In the DSA, health states, starting age, and relative risk of dying were the variables with the greatest influence. The PSA for the base case corroborated the estimates.
Thrombolysis plus mechanical thrombectomy adds quality of life at costs acceptable for decision-makers versus thrombolysis alone. The results are consistent with international studies.
多项研究表明，溶栓联合机械取栓治疗中风比单纯溶栓具有治疗优势。
分析溶栓联合机械取栓与单纯溶栓治疗大血管闭塞性缺血性中风患者的成本效益。
成本效益分析。所使用的模型为混合模型：决策树（前90天）和长期的马尔可夫模型，基于特定疾病量表划分出七种健康状态，从智利公共保险和社会角度进行评估。对质量调整生命年和成本进行评估。进行了确定性分析（DSA）和概率性分析（PSA）。
从公共保险角度来看，在基础案例中，机械取栓在终身范围内成本更低，效益更高（增加2.63个质量调整生命年，1.19个贴现增加生命年），净货币效益（NMB）为37,289,874智利比索，增量成本效益比（ICUR）为3,807,413智利比索/质量调整生命年。对于纳入康复治疗的情景，估计增加2.54个质量调整生命年和1.13个贴现生命年，净货币效益为35,670,319智利比索，增量成本效益比为3,960,624智利比索/质量调整生命年。从社会角度纳入长期护理的情景中，增量成本效益比降至951,911智利比索/质量调整生命年，净货币效益升至43,318,072智利比索，优于先前情景。在确定性分析中，健康状态、起始年龄和死亡相对风险是影响最大的变量。基础案例的概率性分析证实了估计结果。
与单纯溶栓相比，溶栓联合机械取栓能增加生活质量，且成本在决策者可接受范围内。结果与国际研究一致。
