School of Medicine Publications and Presentations
Document Type
Article
Publication Date
10-2021
Abstract
Background It is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.
Methods In the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS(CTP) ischemic core volume (rCBF
Results From 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected lifetime of patients presenting with large core, EVT led to incremental costs of $33 094 and a gain of 1.34 QALYs per patient, resulting in ICER of $24 665 per QALY. EVT has a higher NMB compared with MM at lower (EVT -$42 747, MM -$76 740) and upper (EVT $155 041, MM $57 134) WTP thresholds. PSA confirmed the results and CEAC showed 77% and 92% acceptability of EVT at the WTP of $50 000 and $100 000, respectively. EVT was associated with an increment of $29 225 in societal costs. The pivotal EVT trials (HERMES, DAWN, DEFUSE 3) were dominant in a sensitivity analysis at the same inputs, with societal cost-savings of $37 901, $86 164 and $22 501 and a gain of 1.62, 2.36 and 2.21 QALYs, respectively.
Conclusions In a non-randomized prospective cohort study, EVT resulted in better outcomes in large core patients with higher QALYs, NMB and high cost-effectiveness acceptability rates at current WTP thresholds. Randomized trials are needed to confirm these results.
Clinical trial registration NCT02446587
Recommended Citation
Sarraj, A., Pizzo, E., Lobotesis, K., Grotta, J. C., Hassan, A. E., Abraham, M. G., Blackburn, S., Day, A. L., Dannenbaum, M. J., Hicks, W., Vora, N. A., Budzik, R. F., Sharrief, A. Z., Martin-Schild, S., Sitton, C. W., Pujara, D. K., Lansberg, M. G., Gupta, R., Albers, G. W., Kunz, W. G., … SELECT Investigators (2021). Endovascular thrombectomy in patients with large core ischemic stroke: a cost-effectiveness analysis from the SELECT study. Journal of neurointerventional surgery, 13(10), 875–882. https://doi.org/10.1136/neurintsurg-2020-016766
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Publication Title
Journal of NeuroInterventional Surgery
DOI
10.1136/neurintsurg-2020-016766
Academic Level
faculty
Mentor/PI Department
Neuroscience
Comments
© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.