Background

Recently, two randomized controlled trials demonstrated the benefit of mechanical thrombectomy performed between 6 and 24 h in acute ischemic stroke. The current economic evidence is supporting the intervention only within 6 h, but extended thrombectomy treatment times may result in better long-term outcomes for a larger cohort of patients.

Aims

We compared the cost-utility of mechanical thrombectomy in addition to medical treatment versus medical treatment alone performed beyond 6 h from stroke onset in the UK National Health Service (NHS).

Methods

A cost-utility analysis of mechanical thrombectomy compared to medical treatment was performed using a Markov model that estimates expected costs and quality-adjusted life years (QALYs) over a 20-year time horizon. We present the results of three models using the data from the DEFUSE 3 and DAWN trials and evidence from published sources.

Results

Over a 20-year period, the incremental cost per QALY of mechanical thrombectomy was $1564 (£1219) when performed after 12 h from onset, $5253 (£4096) after 16 h and $3712 (£2894) after 24 h. The probabilistic sensitivity analysis demonstrated that thrombectomy had a 99.9% probability of being cost-effective at the minimum willingness to pay for a QALY commonly used in the UK.

Conclusions

The results of this study demonstrate that performing mechanical thrombectomy up to 24 h from acute ischemic stroke symptom onset is still cost-effective, suggesting that this intervention should be implemented by the NHS on the basis of improvement in quality of life as well as economic grounds.

中文翻译：

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急性缺血性卒中6-24小时机械血栓切除术的成本-效用分析

背景

最近，两项随机对照试验证明了急性缺血性卒中在6至24小时之间进行机械血栓切除术的益处。当前的经济证据仅在6 h内支持干预，但是延长血栓切除术的治疗时间可能会为更多患者带来更好的长期预后。

目的

我们比较了在英国国家卫生服务局（NHS）中将机械血栓切除术除药物治疗之外的成本效用与仅在卒中发生后6小时内单独进行药物治疗的成本效益进行了比较。

方法

使用马尔可夫模型进行机械血栓切除术与药物治疗的成本-效用分析，该模型可估计20年内的预期成本和质量调整生命年（QALYs）。我们使用DEFUSE 3和DAWN试验的数据以及公开来源的证据，介绍了三种模型的结果。

结果

在20年的时间里，机械性血栓切除术每起QALY的增量成本在发病后12小时进行时为1564美元（1219英镑），在16小时后进行5253美元（4096英镑），在24小时后进行3712美元（2894英镑）。概率敏感性分析表明，血栓切除术具有99.9％的成本效益的可能性，而在英国购买QALY的最低意愿是最低的。

结论

这项研究的结果表明，在急性缺血性中风症状发作后24小时内进行机械性血栓切除术仍是具有成本效益的，这表明NHS应在改善生活质量和经济基础的基础上实施这种干预措施。