• Je něco špatně v tomto záznamu ?

Cost-effectiveness of endovascular thrombectomy for acute ischemic stroke with established large infarct in Germany: a decision tree and Markov model

S. Gottschalk, HH. König, F. Subtil, S. Bonekamp, A. Denis, AH. Aamodt, B. Fuentes, ER. Gizewski, MD. Hill, A. Krajina, L. Pierot, CZ. Simonsen, K. Zeleňák, M. Bendszus, G. Thomalla, J. Dams

. 2025 ; 17 (7) : 683-690. [pub] 20250616

Jazyk angličtina Země Anglie, Velká Británie

Typ dokumentu časopisecké články

Perzistentní odkaz   https://www.medvik.cz/link/bmc25015301

BACKGROUND: Recent studies, including the TENSION trial, support the use of endovascular thrombectomy (EVT) in acute ischemic stroke with large infarct (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 3-5). OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective. METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties. RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups. CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.

Citace poskytuje Crossref.org

000      
00000naa a2200000 a 4500
001      
bmc25015301
003      
CZ-PrNML
005      
20250731090911.0
007      
ta
008      
250708s2025 enk f 000 0|eng||
009      
AR
024    7_
$a 10.1136/jnis-2024-021837 $2 doi
035    __
$a (PubMed)38906688
040    __
$a ABA008 $b cze $d ABA008 $e AACR2
041    0_
$a eng
044    __
$a enk
100    1_
$a Gottschalk, Sophie $u Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany s.gottschalk@uke.de $u Hamburg Center for Health Economics, Hamburg, Germany $1 https://orcid.org/0000000269126256
245    10
$a Cost-effectiveness of endovascular thrombectomy for acute ischemic stroke with established large infarct in Germany: a decision tree and Markov model / $c S. Gottschalk, HH. König, F. Subtil, S. Bonekamp, A. Denis, AH. Aamodt, B. Fuentes, ER. Gizewski, MD. Hill, A. Krajina, L. Pierot, CZ. Simonsen, K. Zeleňák, M. Bendszus, G. Thomalla, J. Dams
520    9_
$a BACKGROUND: Recent studies, including the TENSION trial, support the use of endovascular thrombectomy (EVT) in acute ischemic stroke with large infarct (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 3-5). OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective. METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties. RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups. CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.
650    _2
$a lidé $7 D006801
650    12
$a analýza nákladů a výnosů $x metody $7 D003362
650    12
$a trombektomie $x ekonomika $x metody $7 D017131
650    12
$a ischemická cévní mozková příhoda $x ekonomika $x chirurgie $x epidemiologie $7 D000083242
650    12
$a Markovovy řetězce $7 D008390
650    12
$a rozhodovací stromy $7 D003663
650    12
$a endovaskulární výkony $x ekonomika $x metody $7 D057510
650    _2
$a kvalitativně upravené roky života $7 D019057
650    _2
$a mužské pohlaví $7 D008297
650    _2
$a senioři $7 D000368
650    _2
$a ženské pohlaví $7 D005260
651    _2
$a Německo $x epidemiologie $7 D005858
655    _2
$a časopisecké články $7 D016428
700    1_
$a König, Hans-Helmut $u Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany $u Hamburg Center for Health Economics, Hamburg, Germany
700    1_
$a Subtil, Fabien $u Service de Biostatistique, Hospices Civils de Lyon, Lyon, France $u Laboratoire de Biométrie et Biologie Évolutive, Université Lyon 1, Villeurbanne, France
700    1_
$a Bonekamp, Susanne $u Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
700    1_
$a Denis, Angelique $u Service de Biostatistique, Hospices Civils de Lyon, Lyon, France $u Laboratoire de Biométrie et Biologie Évolutive, Université Lyon 1, Villeurbanne, France
700    1_
$a Aamodt, Anne Hege $u Department of Neurology, Oslo University Hospital, Oslo, Norway $u The Norwegian University of Science and Technology, Trondheim, Norway
700    1_
$a Fuentes, Blanca $u Department of Neurology and Stroke Unit, La Paz University Hospital, Madrid, Spain $1 https://orcid.org/000000020363862X
700    1_
$a Gizewski, Elke R $u Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
700    1_
$a Hill, Michael D $u Department of Clinical Neurosciences, Hotchkiss Brain Institute, Health Science Centre, University of Calgary & Foothills Medical Centre, Calgary, Alberta, Canada $1 https://orcid.org/0000000262691543
700    1_
$a Krajina, Antonin $u Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
700    1_
$a Pierot, Laurent $u Department of Neuroradiology, Hôpital Maison-Blanche, Université de Reims Champagne-Ardenne, Reims, France $1 https://orcid.org/0000000225234909
700    1_
$a Simonsen, Claus Ziegler $u Department of Neurology, Aarhus University Hospital, Aarhus, Denmark $1 https://orcid.org/0000000313630266
700    1_
$a Zeleňák, Kamil $u Clinic of Radiology, Jessenius Faculty of Medicine, Comenius University, Martin, Slovakia
700    1_
$a Bendszus, Martin $u Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
700    1_
$a Thomalla, Götz $u Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
700    1_
$a Dams, Judith $u Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany $u Hamburg Center for Health Economics, Hamburg, Germany
773    0_
$w MED00179154 $t Journal of neurointerventional surgery $x 1759-8486 $g Roč. 17, č. 7 (2025), s. 683-690
856    41
$u https://pubmed.ncbi.nlm.nih.gov/38906688 $y Pubmed
910    __
$a ABA008 $b sig $c sign $y - $z 0
990    __
$a 20250708 $b ABA008
991    __
$a 20250731090905 $b ABA008
999    __
$a ok $b bmc $g 2366264 $s 1252426
BAS    __
$a 3
BAS    __
$a PreBMC-MEDLINE
BMC    __
$a 2025 $b 17 $c 7 $d 683-690 $e 20250616 $i 1759-8486 $m Journal of neurointerventional surgery $n J Neurointerv Surg $x MED00179154
LZP    __
$a Pubmed-20250708

Najít záznam

Citační ukazatele

Možnosti archivace