Grunwald Iris Q, Wagner Viola, Podlasek Anna, Koduri Gouri, Guyler Paul, Gerry Stephen, Shah Sweni, Sievert Horst, Sharma Aarti, Mathur Shrey, Fassbender Klaus, Shariat Kaveh, Houston Graeme, Kanodia Avinash, Walter Silke
TIME, Imaging Science and Technology, University of Dundee, Dundee, DD1 4HN, UK.
Cardiovascular Centre, 60389, Frankfurt, Germany.
Cost Eff Resour Alloc. 2022 Nov 4;20(1):59. doi: 10.1186/s12962-022-00395-8.
There is level 1 evidence for cerebral thrombectomy with thrombolysis in acute large vessel occlusion. Many hospitals are now contemplating setting up this life-saving service. For the hospital, however, the first treatment is associated with an initial high cost to cover the procedure. Whilst the health economic benefit of treating stroke is documented, this is the only study to date performing matched-pair, patient-level costing to determine treatment cost within the first hospital episode and up to 90 days post-event.
We conducted a retrospective coarsened exact matched-pair analysis of 50 acute stroke patients eligible for thrombectomy.
Thrombectomy resulted in significantly more good outcomes (mRS 0-2) compared to matched controls (56% vs 8%, p = 0.001). More patients in the thrombectomy group could be discharged home (60% vs 28%), fewer were discharged to nursing homes (4% vs 16%), residential homes (0% vs 12%) or rehabilitation centres (8% vs 20%). Thrombectomy patients had fewer serious adverse events (n = 30 vs 86) and were, on average, discharged 36 days earlier. They required significantly fewer physiotherapy sessions (18.72 vs 46.49, p = 0.0009) resulting in a median reduction in total rehabilitation cost of £4982 (p = 0.0002) per patient. The total cost of additional investigations was £227 lower (p = 0.0369). Overall, the median cost without thrombectomy was £39,664 per case vs £22,444, resulting in median savings of £17,221 (p = 0.0489).
Mechanical thrombectomy improved patient outcome, reduced length of hospitalisation and, even without procedural reimbursement, significantly reduced cost to the thrombectomy providing hospital.
有一级证据支持在急性大血管闭塞时进行脑动脉取栓溶栓治疗。许多医院目前正在考虑开展这项挽救生命的服务。然而，对于医院来说，首次治疗的初始成本很高，用于支付该手术费用。虽然治疗中风的健康经济效益已有文献记载，但这是迄今为止唯一一项进行配对、患者层面成本核算以确定首次住院期间及事件发生后90天内治疗成本的研究。
我们对50例符合取栓治疗条件的急性中风患者进行了回顾性粗精确配对分析。
与配对对照组相比，取栓治疗产生了显著更多的良好预后（改良Rankin量表评分0 - 2分）（56%对8%，p = 0.001）。取栓治疗组更多患者能够出院回家（60%对28%），更少患者被送往养老院（4%对16%）、寄宿护理院（0%对12%）或康复中心（8%对20%）。取栓治疗患者的严重不良事件更少（30例对86例），平均出院时间提前36天。他们所需的物理治疗疗程显著更少（18.72次对46.49次，p = 0.0009），导致每位患者的总康复成本中位数降低4982英镑（p = 0.0002）。额外检查的总成本低227英镑（p = 0.0369）。总体而言，未进行取栓治疗的病例中位数成本为每例39,664英镑，而取栓治疗为22,444英镑，中位数节省17,221英镑（p = 0.0489）。
机械取栓改善了患者预后，缩短了住院时间，即使没有手术费用报销，也显著降低了提供取栓服务医院的成本。
