Makalanda Levansri, Mortimer Alex, Gonzalez-Diaz Eva, Maheswaran Hendramoorthy, Scheffler Shanti, Kottenmeier Emilie, Brinjikji Waleed
Department of Interventional Neuroradiology, Royal London Hospital, Barts Health NHS Trust, London, UK.
Department of Neurointervention, Southmead Hospital, North Bristol NHS Trust, Bristol, UK.
Interv Neuroradiol. 2025 Jul 24:15910199251359730. doi: 10.1177/15910199251359730.
BackgroundBalloon guide catheters (BGCs) are adjunctive devices that may be used during mechanical thrombectomy (MT) to induce flow arrest and improve clot retrieval and reperfusion outcomes for acute ischemic stroke. As the cost-effectiveness of BGC use remains uncertain, this study assessed short- and long-term direct healthcare costs associated with BGC use versus standard guide catheters (SGC) during MT.MethodsA decision tree model estimated the short-term costs (index hospitalization), long-term costs (one year after index hospitalization), and total costs for patients undergoing MT + BGC versus MT + SGC from a healthcare system perspective in the United States (US), Canada, United Kingdom (UK), Sweden, Germany, Italy, Spain, Belgium, and The Netherlands. Average device costs were sourced from public tender prices and market research data. Weighted average healthcare costs for modified Rankin Scale scores were sourced from published literature for the respective countries. A 2024 meta-analysis supporting improved outcomes with BGC provided input parameters to model treatment effects for BGC and SGC. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of model parameters and accounted for uncertainty.ResultsAcross all countries, long-term and total per-patient costs were lower with MT + BGC, yielding total per-patient cost savings of $6297 (US), CAD 3006 (Canada), £1828 (UK), 28,950 kr (Sweden), €1077 (Germany), €709 (Italy), €3678 (Spain), €2259 (Belgium), and €3344 (The Netherlands). The probability of MT + BGC yielding cost savings ranged 0.356-0.911 (short term), 0.962-0.975 (long term), and 0.838-0.935 (total costs). While long-term and total costs consistently favored MT + BGC, short-term cost savings showed more variability across countries.ConclusionThis study demonstrates that BGC use is associated with total one-year per-patient cost savings for inpatient and postdischarge stroke care across the US, Canada, and seven European healthcare systems. Balloon guide catheters can potentially reduce post-stroke care costs and should be considered more broadly, despite the additional cost incurred by the device.
背景
球囊导引导管（BGCs）是一种辅助装置，可在机械取栓术（MT）期间用于诱导血流停滞，并改善急性缺血性卒中的血栓清除和再灌注效果。由于使用BGC的成本效益仍不确定，本研究评估了在美国、加拿大、英国、瑞典、德国、意大利、西班牙、比利时和荷兰，MT期间使用BGC与标准导引导管（SGC）相比的短期和长期直接医疗成本。
方法
从美国、加拿大、英国、瑞典、德国、意大利、西班牙、比利时和荷兰的医疗系统角度出发，采用决策树模型估计接受MT + BGC与MT + SGC治疗的患者的短期成本（首次住院）、长期成本（首次住院后一年）和总成本。平均器械成本来自公开招标价格和市场研究数据。改良Rankin量表评分的加权平均医疗成本来自各国家已发表的文献。一项支持BGC改善预后的2024年荟萃分析为模拟BGC和SGC的治疗效果提供了输入参数。确定性单因素和概率敏感性分析评估了模型参数的稳健性并考虑了不确定性。
结果
在所有国家中，MT + BGC的长期和每位患者的总成本较低，每位患者的总成本节省分别为6297美元（美国）、3006加元（加拿大）、1828英镑（英国）、28950瑞典克朗（瑞典）、1077欧元（德国）、709欧元（意大利）、3678欧元（西班牙）、2259欧元（比利时）和3344欧元（荷兰）。MT + BGC产生成本节省的概率范围为0.356 - 0.911（短期）、0.962 - 0.975（长期）和0.838 - 0.935（总成本）。虽然长期和总成本始终有利于MT + BGC，但短期成本节省在不同国家表现出更大的变异性。
结论
本研究表明，在美国、加拿大和七个欧洲医疗系统中，使用BGC可使每位患者一年的住院和出院后卒中护理总成本节省。球囊导引导管有可能降低卒中后护理成本，尽管该器械会产生额外成本，但应更广泛地予以考虑。
