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Cost-effectiveness of Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review of the Impact of Patient Age. | LitMetric

Cost-effectiveness of Endovascular Therapy for Acute Ischemic Stroke: A Systematic Review of the Impact of Patient Age.

Radiology

From the Departments of Radiology (W.G.K., T.H., F.G.M., B.O.S., M.F.R., B.E., W.H.S., K.M.T.), Neurology (K.D.), and Neuroradiology (F.D.), University Hospital, LMU Munich, Marchioninistr 15, 81377 Munich, Germany; Departments of Radiology and Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands (M.G.H.); Institute for Diagnostic and Interventional Radiology, University Medical Center Rostock, Germany (F.G.M., K.M.T.); and Department of Radiology, Eberhard Karls University of Tuebingen, Tuebingen, Germany (A.E.O.).

Published: August 2018

AI Article Synopsis

Article Abstract

Purpose To determine the impact of patient age on the cost-effectiveness of endovascular therapy (EVT) in addition to standard care (SC) in large-vessel-occlusion stroke for patients aged 50 to 100 years in the United States. Materials and Methods A decision-analytic Markov model was used to estimate direct and indirect lifetime costs and quality-adjusted life years (QALYs). Age-dependent input parameters were obtained from the literature. Deterministic and probabilistic sensitivity analysis for age at index stroke were used. The willingness-to-pay (WTP) was set to thresholds of $50 000, $100 000, and $150 000 per QALY. The study applied a U.S. setting for health care and societal perspectives. Incremental costs and effectiveness were derived from deterministic and probabilistic sensitivity analysis. Acceptability rates at different WTP thresholds were determined. Results EVT+SC was the dominant strategy in patients aged 50 to 79 years. The highest incremental effectiveness (2.61 QALYs) and cost-savings (health care perspective, $99 555; societal perspective, $146 385) were obtained in 50-year-old patients. In octogenarians (80-89 years), EVT+SC led to incremental QALYs at incremental costs with acceptability rates of more than 85%, more than 99%, and more than 99% at a WTP of $50 000, $100 000, and $150 000 per QALY, respectively. In nonagenarians (90-99 years), acceptability rates at a WTP of $50 000 per QALY dropped but stayed higher than 85% and higher than 95% at thresholds of $100 000 and $150 000 per QALY. Conclusion Using contemporary willingness-to-pay thresholds in the United States, endovascular therapy in addition to standard care reduces lifetime costs for patients up to 79 years of age and is cost-effective for patients aged 80 to 100 years.

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Source
http://dx.doi.org/10.1148/radiol.2018172886DOI Listing

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