Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

Background The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population. Methods A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=28... Mehr ...

Verfasser: Van Voorst, Henk
Kunz, Wolfgang G.
Van Den Berg, Lucie A.
Kappelhof, Manon
Pinckaers, Floor M.E.
Goyal, Mayank
Hunink, Myriam G.M.
Emmer, Bart J.
Mulder, Maxim J.H.L.
DIppel, DIederik W.J.
Coutinho, Jonathan M.
Marquering, Henk A.
Boogaarts, Hieronymus D.
Van Der Lugt, Aad
Van Zwam, Wim H.
Roos, Yvo B.W.E.M.
Buskens, Erik
DIjkgraaf, Marcel G.W.
Majoie, Charles B.L.M.
Dokumenttyp: Artikel
Erscheinungsdatum: 2021
Reihe/Periodikum: Van Voorst , H , Kunz , W G , Van Den Berg , L A , Kappelhof , M , Pinckaers , F M E , Goyal , M , Hunink , M G M , Emmer , B J , Mulder , M J H L , DIppel , DI W J , Coutinho , J M , Marquering , H A , Boogaarts , H D , Van Der Lugt , A , Van Zwam , W H , Roos , Y B W E M , Buskens , E , DIjkgraaf , M G W & Majoie , C B L M 2021 , ' Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands ' , Journal of NeuroInterventional Surgery , vol. 13 , no. 12 , pp. 1099-1105 . https://doi.org/10.1136/neurintsurg-2020-017017
Sprache: Englisch
Permalink: https://search.fid-benelux.de/Record/base-26839881
Datenquelle: BASE; Originalkatalog
Powered By: BASE
Link(s) : https://pure.eur.nl/en/publications/21d68309-bfce-4cd0-ae31-71b0edb56c63

Background The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population. Methods A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs. Results EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: -65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs. Conclusion One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.