Inaba Takeshi, Sakuma Mio, Sakakibara Fumihiro, Uchida Kazutaka, Morimoto Takeshi
Department of Clinical Epidemiology, Hyogo Medical University.
Department of Neurosurgery, Hyogo Medical University.
Neurol Med Chir (Tokyo). 2025 Feb 15;65(2):52-60. doi: 10.2176/jns-nmc.2024-0157. Epub 2024 Dec 25.
This study aimed to evaluate the cost-effectiveness of mechanical thrombectomy (MT) in patients aged 90 years and older with acute ischaemic stroke (AIS). We developed a cost-effectiveness model to compare MT with standard medical care (SMC) to SMC alone. The model, incorporating parameters for the effectiveness and costs of MT with SMC and SMC alone, was simulated until the cohort reached 100 years of age. The parameters were estimated from the prospective cohort study of the RESCUE-Japan Registry 2, claims databases, and published literature, with the perspective being Japan's public healthcare system. In the base-case model for an 8-year simulation period, the quality-adjusted life years (QALYs) for MT with SMC and SMC alone were 1.463 and 1.054 years, respectively. The expected costs were 14,553,772 Yen and 13,732,646 Yen, respectively. The incremental cost-effectiveness ratio (ICER) of MT with SMC compared to SMC alone was 2,009,744 Yen per QALY. A probabilistic sensitivity analysis showed a 66% probability that MT with SMC would be below the ICER threshold of 5,000,000 Yen per QALY. The cost-effectiveness analyses demonstrated that performing MT in addition to SMC for AIS in patients aged 90 years and older was acceptable from a cost-effectiveness perspective.
本研究旨在评估机械取栓术（MT）对90岁及以上急性缺血性卒中（AIS）患者的成本效益。我们建立了一个成本效益模型，将MT与标准医疗护理（SMC）单独使用的情况进行比较。该模型纳入了MT联合SMC和单独使用SMC的有效性和成本参数，模拟至队列达到100岁。这些参数是根据RESCUE-Japan Registry 2的前瞻性队列研究、索赔数据库和已发表的文献估计得出的，视角为日本的公共医疗保健系统。在为期8年的模拟期的基础案例模型中，MT联合SMC和单独使用SMC的质量调整生命年（QALY）分别为1.463年和1.054年。预期成本分别为14,553,772日元和13,732,646日元。MT联合SMC相对于单独使用SMC的增量成本效益比（ICER）为每QALY 2,009,744日元。概率敏感性分析显示，MT联合SMC低于每QALY 5,000,000日元的ICER阈值的概率为66%。成本效益分析表明，从成本效益角度来看，在90岁及以上AIS患者中除SMC外进行MT是可以接受的。
