RT Journal Article
SR Electronic
T1 Is Mechanical Clot Removal or Disruption a Cost-Effective Treatment for Acute Stroke?
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 244
OP 249
DO 10.3174/ajnr.A2329
VO 32
IS 2
A1 Nguyen-Huynh, M.N.
A1 Johnston, S.C.
YR 2011
UL http://www.ajnr.org/content/32/2/244.abstract
AB BACKGROUND AND PURPOSE: It is unclear whether the costs and risks of mechanical therapies make them cost-effective. We examined whether interventions such as mechanical clot removal or disruption with angioplasty are cost-effective for acute ischemic stroke compared with best medical therapy. MATERIALS AND METHODS: We performed a cost-utility analysis of patients with acute stroke due to large intracranial artery occlusion presenting beyond the 3-hour window for IV tPA. Model inputs for the mechanical arm were derived from Multi MERCI trial data and a recent meta-analysis. For best medical therapy, we used rates of spontaneous recanalization, ICH, and functional outcomes based on a systematic literature review. Discounted QALYs were determined by using the Markov modeling for 65-year-old patients with acute ischemic stroke. RESULTS: On the basis of a systematic literature review, we modeled an 84% rate of recanalization with mechanical intervention and a 6.3% rate of symptomatic ICH. For best medical therapy, we modeled a spontaneous recanalization rate of 24% with a 2% rate of symptomatic ICH. Mechanical therapies were associated with a $7718 net cost and a gain of a 0.82 QALYs for each use, thus yielding a net of $9386/QALY gained. In sensitivity analyses, results were dependent on the rates of recanalization, symptomatic ICH rates, and costs of treatment. CONCLUSIONS: On the basis of available data, mechanical therapies in qualified patients with acute stroke beyond the window for IV tPA appear to be cost-effective. However, the inputs are not derived from randomized trials, and results are sensitive to several assumptions. CIconfidence intervalECASS IIIEuropean Cooperative Acute Stroke Study IIIFDAUS Food and Drug AdministrationICHintracerebral hemorrhageIVintravenousMERCIMechanical Embolus Removal in Cerebral IschemiamRSmodified Rankin ScaleMS-DRGMedicare Severity-Diagnosis-Related GroupsNIRneurointerventional radiologyPROACT IIProlyse in Acute Cerebral Thromboembolism IIQALYquality-adjusted life-yearRxdrug therapytPAtissue plasminogen activatoryo. w/years old with