Ni Weiyi, Kunz Wolfgang G, Goyal Mayank, Chen Lijin, Jiang Yawen
Department of Pharmaceutical and Health Economics, University of Southern California, Los Angeles, California, USA.
Department of Radiology, University Hospital, LMU Munich, Munich, Germany.
Health Econ Rev. 2022 Jan 6;12(1):4. doi: 10.1186/s13561-021-00352-w.
Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China.
A model combining a short-term decision tree and long-term Markov health state transition matrix was constructed. For each time window of symptom onset to EVT, the probability of receiving EVT or non-EVT treatment was varied, thereby varying clinical outcomes and healthcare costs. Clinical outcomes and cost data were derived from clinical trials and literature. Incremental cost-effectiveness ratio and incremental net monetary benefits were simulated. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model. The willingness-to-pay threshold per quality-adjusted life-year (QALY) was set to ¥71,000 ($10,281).
EVT performed between 61 and 120 min after the stroke onset was most cost-effective comparing to other time windows to perform EVT among AIS patients in China, with an ICER of ¥16,409/QALY ($2376) for performing EVT at 61-120 min versus the time window of 301-360 min. Each hour delay in EVT resulted in an average loss of 0.45 QALYs and 165.02 healthy days, with an average net monetary loss of ¥15,105 ($2187).
Earlier treatment of acute ischemic stroke patients with EVT in China increases lifetime QALYs and the economic value of care without any net increase in lifetime costs. Thus, healthcare policies should aim to improve efficiency of pre-hospital and in-hospital workflow processes to reduce the onset-to-puncture duration in China.
尽管血管内治疗（EVT）可改善急性缺血性脑卒中患者的临床结局，但开始EVT的时间对临床结局和医疗成本有显著影响。本研究评估了在中国EVT治疗延迟对成本效益的影响。
构建了一个结合短期决策树和长期马尔可夫健康状态转换矩阵的模型。对于症状发作至EVT的每个时间窗，接受EVT或非EVT治疗的概率各不相同，从而使临床结局和医疗成本有所不同。临床结局和成本数据来源于临床试验和文献。模拟了增量成本效益比和增量净货币效益。进行了确定性和概率性敏感性分析以评估模型的稳健性。将每质量调整生命年（QALY）的支付意愿阈值设定为71,000元人民币（10,281美元）。
与中国急性缺血性脑卒中（AIS）患者进行EVT的其他时间窗相比，在卒中发作后61至120分钟进行EVT最具成本效益，在61 - 120分钟进行EVT与301 - 360分钟时间窗相比，增量成本效益比为16,409元人民币/QALY（2376美元）。EVT每延迟一小时平均损失0.45个QALY和165.02个健康日，平均净货币损失为15,105元人民币（2187美元）。
在中国，对急性缺血性脑卒中患者尽早进行EVT治疗可增加终身QALY和护理的经济价值，而不会使终身成本有任何净增加。因此，医疗政策应旨在提高院前和院内工作流程的效率，以缩短中国从发病到穿刺的时间。
