Egashira Shuhei, Shin Jung-Ho, Yoshimura Sohei, Koga Masatoshi, Ihara Masafumi, Kimura Naoto, Toda Tatsushi, Imanaka Yuichi
Department of Healthcare Economics and Quality Management, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
J Neurointerv Surg. 2024 Dec 26;17(e1):e60-e67. doi: 10.1136/jnis-2023-021068.
Although randomized clinical trials (RCTs) demonstrated short-term benefits of endovascular therapy (EVT) for acute ischemic stroke (AIS) with a large ischemic region, little is known about the long-term cost-effectiveness or its difference by the extent of the ischemic areas. We aimed to assess the cost-effectiveness of EVT for AIS involving a large ischemic region from the perspective of Japanese health insurance payers, and analyze it using the Alberta Stroke Program Early CT Score (ASPECTS).
The Recovery by Endovascular Salvage for Cerebral Ultra-acute Embolism-Japan Large Ischemic Core Trial (RESCUE-Japan LIMIT) was a RCT enrolling AIS patients with ASPECTS of 3-5 initially determined by the treating neurologist primarily using MRI. The hypothetical cohort and treatment efficacy were derived from the RESCUE-Japan LIMIT. Costs were calculated using the national health insurance tariff. We stratified the cohort into two subgroups based on ASPECTS of ≤3 and 4-5 as determined by the imaging committee, because heterogeneity was observed in treatment efficacy. EVT was considered cost-effective if the incremental cost-effectiveness ratio (ICER) was below the willingness-to-pay of 5 000 000 Japanese yen (JPY)/quality-adjusted life year (QALY).
EVT was cost-effective among the RESCUE-Japan LIMIT population (ICER 4 826 911 JPY/QALY). The ICER among those with ASPECTS of ≤3 and 4-5 was 19 396 253 and 561 582 JPY/QALY, respectively.
EVT was cost-effective for patients with AIS involving a large ischemic region with ASPECTS of 3-5 initially determined by the treating neurologist in Japan. However, the ICER was over 5 000 000 JPY/QALY among those with an ASPECTS of ≤3 as determined by the imaging committee.
尽管随机临床试验（RCT）证明血管内治疗（EVT）对具有大面积缺血区域的急性缺血性卒中（AIS）有短期益处，但对于长期成本效益或其在缺血区域范围方面的差异知之甚少。我们旨在从日本医疗保险支付者的角度评估EVT对涉及大面积缺血区域的AIS的成本效益，并使用阿尔伯塔卒中项目早期CT评分（ASPECTS）进行分析。
脑超急性栓塞血管内挽救恢复 - 日本大面积缺血核心试验（RESCUE - Japan LIMIT）是一项RCT，纳入最初由主治神经科医生主要使用MRI确定ASPECTS为3 - 5的AIS患者。假设队列和治疗效果来自RESCUE - Japan LIMIT。成本使用国家医疗保险费率计算。由于在治疗效果中观察到异质性，我们根据影像委员会确定的ASPECTS≤3和4 - 5将队列分为两个亚组。如果增量成本效益比（ICER）低于5000000日元（JPY）/质量调整生命年（QALY）的支付意愿，则认为EVT具有成本效益。
在RESCUE - Japan LIMIT人群中，EVT具有成本效益（ICER为4826911 JPY/QALY）。ASPECTS≤3和4 - 5的患者的ICER分别为19396253和561582 JPY/QALY。
对于日本主治神经科医生最初确定ASPECTS为3 - 5且涉及大面积缺血区域的AIS患者，EVT具有成本效益。然而，根据影像委员会确定，ASPECTS≤3的患者中ICER超过5000000 JPY/QALY。
