de Souza Ana Claudia, Martins Sheila O, Polanczyk Carisi Anne, Araújo Denizar Vianna, Etges Ana Paula Bs, Zanotto Bruna Stella, Neyeloff Jeruza Lavanholi, Carbonera Leonardo Augusto, Chaves Márcia Lorena Fagundes, de Carvalho João José Freitas, Rebello Letícia Costa, Abud Daniel Giansante, Cabral Lucas Scotta, Lima Fabrício O, Mont'Alverne Francisco, Sc Magalhães Pedro, Diegoli Henrique, Safanelli Juliana, André Silveira Salvetti Thales, de Sousa Mendes Parente Bruno, Eli Frudit Michel, Silva Gisele Sampaio, Pontes-Neto Octávio M, Nogueira Raul G
Department of Neurology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
National Institute of Science and Technology for Health Technology Assessment (IATS), Porto Alegre, Brazil.
Int J Stroke. 2021 Nov 3:17474930211055932. doi: 10.1177/17474930211055932.
The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil.
This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective.
A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results.
The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold.
The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.
RESILIENT试验证明了在巴西，机械取栓术对因前循环大血管闭塞导致急性缺血性卒中患者的临床益处。
本经济评估旨在从公共医疗保健角度评估RESILIENT试验中机械取栓术的成本效益。
应用成本效益分析，从RESILIENT试验的一个子样本（221例患者中的151例）中比较机械取栓术联合标准医疗护理（n = 78）与单纯标准医疗护理（n = 73）。考虑实际直接成本，并根据效用加权改良Rankin量表估算效用。构建了一个马尔可夫模型，并进行了概率和确定性敏感性分析，以评估结果的稳健性。
与单纯标准医疗护理相比，机械取栓术联合标准医疗护理增加的成本和获得的质量调整生命年分别估计为7440国际元（Int$）和1.04，每质量调整生命年的增量成本效益比为7153国际元。确定性敏感性分析表明，第一年的改良Rankin量表6分（mRS-6）成本对增量成本效益比影响最大。经过1000次模拟，大多数结果低于成本效益阈值。
在巴西公共医疗保健系统中，该干预措施明显的长期益处抵消了机械取栓术最初较高的成本。这种治疗方法可能具有成本效益，这些结果对于将机械取栓术纳入巴西公共卒中中心至关重要。
