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Real-world cost-effectiveness of late time window thrombectomy for patients With ischemic stroke

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dc.contributor.authorGao, L.
dc.contributor.authorBivard, A.
dc.contributor.authorParsons, M.
dc.contributor.authorSpratt, N.J.
dc.contributor.authorLevi, C.
dc.contributor.authorButcher, K.
dc.contributor.authorKleinig, T.
dc.contributor.authorYan, B.
dc.contributor.authorDong, Q.
dc.contributor.authorCheng, X.
dc.contributor.authorLou, M.
dc.contributor.authorYin, C.
dc.contributor.authorChen, C.
dc.contributor.authorWang, P.
dc.contributor.authorLin, L.
dc.contributor.authorChoi, P.
dc.contributor.authorMiteff, F.
dc.contributor.authorMoodie, M.
dc.date.issued2021
dc.description.abstractBackground: To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for patients with ischemic stroke in the >4.5 h time window between patient groups who met and did not meet the perfusion imaging trial criteria.Methods: A discrete event simulation (DES) model was developed to simulate the long-term outcome post EVT in patients meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, vs. medical treatment alone (including intravenous thrombolysis). The effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischemic stroke, between 2015 and 2019, in the extended time window (>4.5 h). Results: Endovascular thrombectomy was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort [incremental cost-effectiveness ratio (ICER) of $11,608/quality-adjusted life year (QALY) for DEFUSE 3-postive or $34,416/QALY for DAWN-positive]. However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (−1.02 QALY for DEFUSE 3; −1.43 QALY for DAWN) and higher long-term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), thereby making it unlikely to be cost-effective in Australia.Conclusions: Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT was associated with less gain in QALYs and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.
dc.description.statementofresponsibilityLan Gao, Andrew Bivard, Mark Parsons, Neil J. Spratt, Christopher Levi, Kenneth Butcher ... et al.
dc.identifier.citationFrontiers in Neurology, 2021; 12:1-9
dc.identifier.doi10.3389/fneur.2021.780894
dc.identifier.issn1664-2295
dc.identifier.issn1664-2295
dc.identifier.orcidKleinig, T. [0000-0003-4430-3276]
dc.identifier.urihttps://hdl.handle.net/2440/134326
dc.language.isoen
dc.publisherFrontiers Media
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1110629
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/100827
dc.rights© 2021 Gao, Bivard, Parsons, Spratt, Levi, Butcher, Kleinig, Yan, Dong, Cheng, Lou, Yin, Chen, Wang, Lin, Choi, Miteff and Moodie. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
dc.source.urihttps://doi.org/10.3389/fneur.2021.780894
dc.subjectStroke; large vessel occlusions; late time window thrombectomy; real-world; cost-effectiveness
dc.titleReal-world cost-effectiveness of late time window thrombectomy for patients With ischemic stroke
dc.typeJournal article
pubs.publication-statusPublished

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