Cost-effectiveness of two endovascular treatment strategies vs intravenous thrombolysis

J. C. Bouvy, P. S.S. Fransen, S. A. Baeten, M. A. Koopmanschap, L. W. Niessen, D. W.J. Dippel

Research output: Contribution to journalArticle

Abstract

Objective: To assess the cost-effectiveness of endovascular treatment against intravenous thrombolysis (IVT) when varying assumptions concerning its effectiveness. Methods: We developed a health economic model including a hypothetical population consisting of patients with ischemic stroke, admitted within 4.5 h from onset, without contraindications for IVT or intra-arterial treatment (IAT). A decision tree and life table were used to assess 6-month and lifetime costs (in Euros) and effects in quality-adjusted life years treatment with IVT alone, IAT alone, and IVT followed by IAT if the patient did not respond to treatment. Several analyses were performed to explore the impact of considerable uncertainty concerning the clinical effectiveness of endovascular treatment. Results: Probabilistic sensitivity analysis demonstrated a 54% probability of positive incremental lifetime effectiveness of IVT-IAT vs IVT alone. Sensitivity analyses showed significant variation in outcomes and cost-effectiveness of the included treatment strategies at different model assumptions. Conclusions: Acceptable cost-effectiveness of IVT-IAT compared to IVT will only be possible if recanalization rates are sufficiently high (>50%), treatment costs of IVT-IAT do not increase, and complication rates remain similar to those reported in the few randomized studies published to date. Large randomized studies are needed to reduce the uncertainty concerning the effects of endovascular treatment.

Original languageEnglish (US)
Pages (from-to)351-359
Number of pages9
JournalActa Neurologica Scandinavica
Volume127
Issue number5
DOIs
StatePublished - May 1 2013

Keywords

  • Cerebrovascular disease
  • Cost-effectiveness analysis
  • Economic modeling
  • Stroke

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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  • Cite this

    Bouvy, J. C., Fransen, P. S. S., Baeten, S. A., Koopmanschap, M. A., Niessen, L. W., & Dippel, D. W. J. (2013). Cost-effectiveness of two endovascular treatment strategies vs intravenous thrombolysis. Acta Neurologica Scandinavica, 127(5), 351-359. https://doi.org/10.1111/ane.12065