支架取栓术选择治疗急性缺血性脑卒中的经济影响:基于中国医疗体系视角下 MASTRO I 数据的成本效果分析。
The economic impact associated with stent retriever selection for the treatment of acute ischemic stroke: a cost-effectiveness analysis of MASTRO I data from a Chinese healthcare system perspective.
机构信息
Mercy St Vincent Medical Center, Toledo, OH 43608, USA.
Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, 510123, China.
出版信息
J Comp Eff Res. 2024 Nov;13(11):e240160. doi: 10.57264/cer-2024-0160. Epub 2024 Nov 5.
The aim of this analysis was to assess the cost-effectiveness of the EmboTrap Revascularization Device compared with the Solitaire™ Revascularization Device and Trevo Retriever for the treatment of acute ischemic stroke (AIS) from the perspective of the Chinese healthcare system. According to MASTRO I, a recent living systematic literature review and meta-analysis, mechanical thrombectomy (MT) with EmboTrap in the treatment of AIS resulted in better functional outcomes compared with the use of Solitaire or Trevo. Based on the proportion of patients that achieved 90-day modified Rankin Scale (mRS) scores of 0-2, 3-5 and 6 reported in MASTRO I, a combined 90-day short-term decision tree and Markov model with a 10-year time horizon was used to compare the cost-effectiveness of the three devices. The primary outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost (in 2022 Chinese Yuan [CNY]) per incremental quality-adjusted life-year (QALY). The ICERs were compared against willingness-to-pay (WTP) thresholds of 1, 1.5 and 3-times the 2022 national gross domestic product (GDP) per capita in China. Treatment with EmboTrap resulted in total QALYs of 3.28 and total costs of 110,058 CNY per patient. Treatment with Trevo resulted in total QALYs of 3.05 and total costs of 116,941 CNY per patient. Treatment with Solitaire resulted in total QALYs of 2.81 and total costs of 99,090 CNY per patient. Trevo was dominated by EmboTrap as it was a more costly and less effective intervention. As such, Trevo was not cost-effective at any WTP threshold. Compared with Solitaire, EmboTrap was more effective and more costly, with an ICER of 23,615 CNY per QALY. This result suggests that EmboTrap is cost-effective when compared with Solitaire since the ICER was lower than all WTP thresholds assessed. EmboTrap dominated Trevo and is cost-effective for the treatment of patients with AIS compared with Solitaire when assessed from the perspective of the Chinese healthcare system and based on the device-level meta-analysis MASTRO I. Selecting a stent retriever (SR) that optimizes 90-day mRS score is an important consideration from both a clinical and healthcare payer perspective in China as it is associated with reduced long-term costs and increased quality of life.
本分析旨在从中国医疗体系的角度评估 EmboTrap 血管再通装置与 Solitaire™ 血管再通装置和 Trevo 取栓装置治疗急性缺血性脑卒中(AIS)的成本效益。根据 MASTRO I 的一项近期系统文献综述和荟萃分析,与使用 Solitaire 或 Trevo 相比,EmboTrap 机械血栓切除术(MT)治疗 AIS 可获得更好的功能结局。根据 MASTRO I 报告的 90 天改良 Rankin 量表(mRS)评分 0-2、3-5 和 6 的患者比例,使用联合 90 天短期决策树和 Markov 模型(10 年时间范围)比较三种设备的成本效益。主要结果是增量成本效益比(ICER),代表每增加一个质量调整生命年(QALY)的增量成本(2022 年中国人民币[CNY])。将 ICER 与中国 1 倍、1.5 倍和 3 倍于 2022 年全国人均国内生产总值(GDP)的意愿支付(WTP)阈值进行比较。EmboTrap 治疗的总 QALY 为 3.28,每位患者的总成本为 110,058 CNY。Trevo 治疗的总 QALY 为 3.05,每位患者的总成本为 116,941 CNY。Solitaire 治疗的总 QALY 为 2.81,每位患者的总成本为 99,090 CNY。Trevo 优于 EmboTrap,因为它的成本更高,效果更差。因此,在任何 WTP 阈值下,Trevo 都不具有成本效益。与 Solitaire 相比,EmboTrap 更有效且成本更高,ICER 为每 QALY 23,615 CNY。这一结果表明,与 Solitaire 相比,EmboTrap 具有成本效益,因为 ICER 低于评估的所有 WTP 阈值。从中国医疗体系的角度来看,基于 MASTRO I 的设备水平荟萃分析,EmboTrap 优于 Trevo,与 Solitaire 相比,EmboTrap 治疗 AIS 患者具有成本效益。从临床和医疗支付者的角度来看,选择能够优化 90 天 mRS 评分的支架取栓器(SR)是一个重要的考虑因素,因为它与降低长期成本和提高生活质量有关。