Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA.
Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
World Neurosurg. 2023 Jul;175:e730-e737. doi: 10.1016/j.wneu.2023.04.012. Epub 2023 Apr 8.
To determine the cost-effectiveness of mechanical thrombectomy (MT) versus best medical management (BMM) in patients aged ≥80 years.
We performed a systematic literature review to identify comparative studies of MT versus BMM with or without intravenous tissue-type plasminogen activator (IV tPA) in patients ≥80 years. Clinical data including outcomes and mortality categorized as modified Rankin scale scores 0-2, 3-5, and 6, were collected from identified studies, and effectiveness scores were assigned to each outcome. Costs associated with stroke outcomes were derived from previous literature, including costs associated with initial and follow-up imaging, hospitalization, physicians/associated personnel, and MT. TreeAge Pro software was used to construct a cost-effectiveness analysis model of clinical data from studies and costs derived from the literature.
The review identified 1 relevant comparative study. The cost model demonstrated total annual cumulative overall per-patient costs of $30,064.21 for BMM with IV tPA and $21,940.36 for BMM without IV tPA. Overall effectiveness scores were 0.61 and 0.62, respectively. MT had a cumulative total annual per-patient cost of $47,849.54 and an overall effectiveness score of 0.40. The cost-effectiveness ratios of total cumulative patient cost to overall outcome effectiveness score for the 3 treatments were as follows: BMM with IV tPA = $49,285.59, BMM without IV tPA = $35,387.58, and MT = $119,623.85. BMM with or without IV tPA was found to be more cost-effective than MT.
This study utilized stroke outcomes data for patients aged ≥80 years to conduct a cost-effectiveness analysis. MT was found to be less cost-effective than BMM with and without IV tPA.
评估 80 岁及以上患者采用机械血栓切除术（MT）与最佳药物治疗（BMM）的成本效益。
我们系统地检索了比较 80 岁及以上患者接受 MT 与 BMM（联合或不联合静脉组织型纤溶酶原激活剂[IV tPA]）治疗的研究，收集了包括改良 Rankin 量表评分 0-2、3-5 和 6 在内的临床结局和死亡率数据，并为每个结局分配了有效性评分。来自既往文献的成本数据包括与初始和随访影像学、住院、医师/相关人员和 MT 相关的成本。TreeAge Pro 软件用于构建从研究中获得的临床数据和从文献中推导的成本的成本效益分析模型。
该综述确定了 1 项相关的比较研究。成本模型显示，联合 IV tPA 的 BMM 方案每年每位患者的总累积费用为 30064.21 美元，不联合 IV tPA 的 BMM 方案为 21940.36 美元。相应的总体有效性评分分别为 0.61 和 0.62。MT 方案每年每位患者的总累积费用为 47849.54 美元，总体有效性评分为 0.40。3 种治疗方案的总累积患者成本与总体结局有效性评分的成本效益比分别为：联合 IV tPA 的 BMM 方案为 49285.59 美元，不联合 IV tPA 的 BMM 方案为 35387.58 美元，MT 方案为 119623.85 美元。结果显示，联合 IV tPA 的 BMM 方案和不联合 IV tPA 的 BMM 方案比 MT 更具成本效益。
本研究使用 80 岁及以上患者的卒中结局数据进行了成本效益分析。MT 比联合或不联合 IV tPA 的 BMM 方案的成本效益比更低。
