Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA.
Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA.
Eur Radiol. 2022 Jun;32(6):3757-3766. doi: 10.1007/s00330-022-08671-0. Epub 2022 Mar 17.
The objective of this study was to examine the published cost-effectiveness analyses (CEAs) on endovascular thrombectomy (EVT) in acute stroke patients, with a particular focus on the practice of accounting for costs and utilities.
We conducted a systematic review of published CEAs on EVT in acute stroke patients from 1/1/2009 to 10/1/2019. Published CEAs were searched in Ovid Embase, Ovid MEDLINE, and Web of Science. Cost or comparative effectiveness analyses were excluded. Risk of bias and quality assessment was based on the Consolidated Health Economic Evaluation Reporting Standard checklist.
Twenty-one studies were included in the final analysis, from the USA, Canada, Europe, Asia, and Australia. They all concluded EVT to be cost-effective, but with significant variations in methodology. Fifteen studies employed a long-term horizon (> 20 years), while only 11 incorporated risk of recurrent strokes. The willingness-to-pay (WTP) threshold varied from $10,000/quality-adjusted life year (QALY) to $120,000/QALY, with $50,000/QALY and $100,000/QALY being the most commonly used. Five studies undertook a societal perspective, but only one accounted for indirect costs. Seventeen studies based outcomes on 90-day modified Rankin Scale (mRS) scores, and 9 of these 17 studies grouped outcomes by mRS 0-2 and 3-5. Among these 9 studies, the range of QALY score reported for mRS 0-2 was 0.71-0.85 QALY, and that of mRS 3-5 was 0.21-0.40.
Our study reveals significant heterogeneity in previously published thrombectomy CEAs, highlighting need for better standardization in future CEAs.
• All included studies concluded thrombectomy to be cost-effective, from both long- and short-term perspectives. • Only 5 out of 22 studies undertook a societal perspective, and only 1 accounted for indirect costs. • The range of value for mRS 0-2 was 0.71-0.85 quality-adjusted life year (QALY) and 0.21-0.40 QALY for mRS 3-5.
本研究旨在检查急性脑卒中患者血管内血栓切除术（EVT）的已发表成本效益分析（CEA），特别关注成本和效用的核算实践。
我们对 2009 年 1 月 1 日至 2019 年 10 月 1 日发表的急性脑卒中患者 EVT 的已发表 CEA 进行了系统回顾。在 Ovid Embase、Ovid MEDLINE 和 Web of Science 中搜索已发表的成本或比较效益分析。排除成本或比较效益分析。根据统一健康经济评估报告标准清单对偏倚风险和质量评估进行评估。
最终分析纳入了 21 项研究，来自美国、加拿大、欧洲、亚洲和澳大利亚。它们都得出结论认为 EVT 具有成本效益，但方法存在显著差异。15 项研究采用了长期（>20 年）视角，而只有 11 项研究纳入了复发中风的风险。意愿支付（WTP）阈值从 10000 美元/QALY 到 120000 美元/QALY 不等，其中 50000 美元/QALY 和 100000 美元/QALY 最为常用。5 项研究采用了社会视角，但只有 1 项研究考虑了间接成本。17 项研究的结果基于 90 天改良 Rankin 量表（mRS）评分，其中 17 项研究中有 9 项将结果按 mRS 0-2 和 3-5 进行分组。在这 9 项研究中，mRS 0-2 报告的 QALY 评分范围为 0.71-0.85 QALY，mRS 3-5 的评分范围为 0.21-0.40。
我们的研究表明，先前发表的取栓 CEA 存在显著的异质性，突出表明需要在未来的 CEA 中更好地标准化。
所有纳入的研究均从长期和短期角度得出取栓具有成本效益的结论。
只有 5 项研究采用了社会视角，只有 1 项研究考虑了间接成本。
mRS 0-2 的 QALY 值范围为 0.71-0.85，mRS 3-5 的 QALY 值范围为 0.21-0.40。
