疑似大血管闭塞患者直接转入血管造影室的成本效益。
Cost-effectiveness of Direct Transfer to Angiography Suite of Patients With Suspected Large Vessel Occlusion.
机构信息
From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center.
出版信息
Neurology. 2023 Sep 5;101(10):e1036-e1045. doi: 10.1212/WNL.0000000000207583. Epub 2023 Jul 12.
BACKGROUND AND OBJECTIVES
Patients with acute ischemic stroke due to large vessel occlusion (LVO) deemed eligible for endovascular thrombectomy (EVT) are transferred from the emergency room to the angiography suite to undergo the procedure. Recently, the strategy of direct transfer of patients with suspected LVO to the angiography suite (DTAS) has been shown to improve functional outcomes. This study aims to evaluate the cost-effectiveness of the DTAS strategy vs initial transfer of patients with suspected LVO (Rapid Arterial Occlusion Evaluation score >4 and NIH Stroke Scale >10) to the emergency room (ITER).
METHODS
A decision-analytic Markov model was developed to estimate the cost-effectiveness of the DTAS strategy vs the ITER strategy from a Dutch health care perspective with a 10-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER) using Dutch thresholds of $59,135 (€50,000) and $94,616 (€80,000) per quality-adjusted life year (QALY). Uncertainty of input parameters was assessed using 1-way sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis.
RESULTS
The DTAS strategy yielded 0.65 additional QALYs at an additional $16,089, resulting in an ICER of $24,925/QALY compared with the ITER strategy. The ICER varied from $27,169 to $38,325/QALY across different scenarios. The probabilistic sensitivity analysis showed that the DTAS strategy had a 91.8% and 97.0% likelihood of being cost-effective at a decision threshold of $59,135/QALY and $94,616/QALY, respectively.
DISCUSSION
The cost-effectiveness of the DTAS strategy over ITER is robust for patients with suspected LVO. Together with recently published clinical results, this means that implementation of the DTAS strategy may be considered to improve the workflow and outcome of EVT.
背景与目的
对于适合血管内血栓切除术（EVT）的大血管闭塞（LVO）导致的急性缺血性脑卒中患者，将从急诊室转至血管造影室进行该手术。最近，直接将疑似 LVO 患者转入血管造影室（DTAS）的策略已被证明可改善功能预后。本研究旨在评估 DTAS 策略相对于将疑似 LVO 患者（快速动脉闭塞评估评分＞4 分和 NIH 卒中量表＞10 分）初始转入急诊室（ITER）的成本效益。
方法
采用决策分析马尔可夫模型，从荷兰医疗保健的角度出发，在 10 年的时间范围内，估算 DTAS 策略相对于 ITER 策略的成本效益。主要结局是使用荷兰阈值（59135 美元[50000 欧元]和 94616 美元[80000 欧元]）每质量调整生命年（QALY）计算增量成本效益比（ICER）。采用单因素敏感性分析、情景分析和概率敏感性分析评估输入参数的不确定性。
结果
与 ITER 策略相比，DTAS 策略可增加 0.65 个 QALY，增加 16089 美元，ICER 为 24925 美元/QALY。在不同的情景下，ICER 从 27169 美元到 38325 美元/QALY 不等。概率敏感性分析表明，DTAS 策略在决策阈值为 59135 美元/QALY 和 94616 美元/QALY 时，具有 91.8%和 97.0%的可能性具有成本效益。
讨论
DTAS 策略相对于 ITER 在疑似 LVO 患者中的成本效益是稳健的。结合最近发表的临床结果，这意味着实施 DTAS 策略可能有助于改善 EVT 的工作流程和结果。
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