Sanmartin Maria X, Katz Jeffrey M, Eusemann Christian, Boltyenkov Artem T, Sangha Kinpritma, Bastani Mehrad, Turner Raymond, Siddiqui Adnan H, Mendes Pereira Vitor, Hui Ferdinand K, Mocco J, Sanelli Pina C
1Center for Health Innovations and Outcomes Research (CHIOR), Feinstein Institutes for Medical Research, Manhasset.
3Siemens Medical Solutions USA Inc., Malvern, Pennsylvania.
J Neurosurg. 2023 Jan 20;139(3):721-731. doi: 10.3171/2022.12.JNS222115. Print 2023 Sep 1.
Clinical outcomes following endovascular thrombectomy (EVT) for acute ischemic stroke (AIS) treatment are highly time sensitive. Remote robotic (RR)-EVT systems may be capable of mitigating time delays in patient transfer from a primary stroke center (PSC) to a comprehensive/thrombectomy-capable stroke center. However, health economic evidence is needed to assess the costs and benefits of an RR-EVT system. Therefore, the authors of this study aimed to determine whether performing RR-EVT in suspected AIS patients at a PSC as opposed to standard of care might translate to cost-effectiveness over a lifetime.
An economic evaluation study was performed from a US healthcare perspective, combining decision analysis and Markov modeling methods over a lifetime horizon to evaluate the cost-effectiveness of RR-EVT in suspected AIS patients at a PSC compared to the standard-of-care approach. Total expected costs and quality-adjusted life-years (QALYs) were estimated.
In the cost-effectiveness analysis, RR-EVT yielded greater effectiveness per patient (4.05 vs 3.88 QALYs) and lower costs (US$321,269 vs US$321,397) than the standard-of-care approach. Owing to these lower costs and greater health benefits, RR-EVT was the dominant cost-effective strategy. After initiation of an RR-EVT system, the average costs per year were similar (or slightly reduced), according to this simulation. Sensitivity analyses revealed that RR-EVT remains cost-effective in a wide variety of time delays and cost assumptions. In a one-way sensitivity analysis, RR-EVT remained the most cost-effective strategy when time delays were greater than 2.5 minutes, its complication rate did not exceed 37%, and costs were lower than $54,081. When the cost of the RR-EVT strategy ranged from $19,340 to $54,081 and its complication rate varied from 15% to 37%, the RR-EVT strategy remained the most cost-effective throughout the two ranges. RR-EVT was also the most cost-effective strategy even when its cost doubled (to approximately $40,000) and time delays exceeded 20 minutes. In a probabilistic sensitivity analysis, RR-EVT was the long-term cost-effective strategy in 89.8% of iterations at a willingness-to-pay threshold of $100,000/QALY.
This analysis suggests that RR-EVT as an innovative solution to expedite EVT is cost-effective. An RR-EVT system could potentially extend access to care in underserved communities and rural areas, as well as improve care for socioeconomically disadvantaged populations affected by health inequities.
急性缺血性卒中（AIS）治疗中血管内血栓切除术（EVT）后的临床结局对时间高度敏感。远程机器人（RR）-EVT系统或许能够减少患者从初级卒中中心（PSC）转运至具备综合/血栓切除术能力的卒中中心时的时间延迟。然而，需要卫生经济学证据来评估RR-EVT系统的成本和效益。因此，本研究的作者旨在确定在PSC对疑似AIS患者实施RR-EVT而非标准治疗在其一生中是否具有成本效益。
从美国医疗保健的角度进行了一项经济评估研究，结合决策分析和马尔可夫建模方法，在患者一生中评估PSC中疑似AIS患者采用RR-EVT与标准治疗方法相比的成本效益。估计了总预期成本和质量调整生命年（QALY）。
在成本效益分析中，与标准治疗方法相比，RR-EVT每名患者产生了更高的效益（4.05个QALY对3.88个QALY）和更低的成本（321,269美元对321,397美元）。由于成本更低且健康效益更高，RR-EVT是主要的成本效益策略。根据该模拟，启动RR-EVT系统后，每年的平均成本相似（或略有降低）。敏感性分析表明，在各种时间延迟和成本假设下RR-EVT仍具有成本效益。在单因素敏感性分析中，当时间延迟大于2.5分钟、其并发症发生率不超过37%且成本低于54,081美元时，RR-EVT仍是最具成本效益的策略。当RR-EVT策略的成本在19,340美元至54,081美元之间且其并发症发生率在15%至37%之间变化时，RR-EVT策略在这两个范围内始终是最具成本效益的。即使RR-EVT的成本翻倍（至约40,000美元）且时间延迟超过20分钟，它仍是最具成本效益的策略。在概率敏感性分析中，如果支付意愿阈值为100,000美元/QALY，RR-EVT在89.8%的迭代中是长期成本效益策略。
该分析表明，RR-EVT作为加快EVT的创新解决方案具有成本效益。RR-EVT系统可能会扩大医疗服务可及性，覆盖医疗服务不足的社区和农村地区，同时改善受健康不平等影响的社会经济弱势群体的医疗服务。
