Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care.
Cost-Consequence Analysis of Advanced Imaging in Acute Ischemic Stroke Care.
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DOI：
10.3389/fneur.2021.774657
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发表时间：
2021
影响因子：
3.4
通讯作者：
Sanelli PC
中科院分区：
文献类型：
--
作者：
Boltyenkov AT;Martinez G;Pandya A;Katz JM;Wang JJ;Naidich JJ;Rula E;Sanelli PC
简介：本研究的目的是说明在综合性卒中中心（CSC）对出现急性缺血性卒中（AIS）症状的患者实施高级CT血管造影和灌注（CTAP）作为初始成像的潜在成本和健康后果。研究方法：根据美国心脏协会对AIS护理途径的建议，开发了一个决策模拟模型，以从机构角度评估5年期的成像策略。比较了以下策略：（1）高级CTAP成像：在就诊时进行NCCT + CTA + CT灌注;（2）标准治疗：在就诊时进行非造影CT（NCCT），仅在选定患者中进行CT血管造影（CTA）± CT灌注（初始成像以排除出血和广泛缺血），以进行机械血栓切除术（MT）评价。模型参数的定义与循证数据。进行了成本-后果和敏感性分析。使用90天时的改良兰金量表（mRS）作为结局指标。结果如下：决策模拟模型显示，采用先进的CTAP成像使每位患者的成像成本增加了1.19%（9.28美元/779.72美元），每位患者的治疗成本增加了33.25%（729.96美元/2195.24美元），其他每位患者的急诊护理成本降低了0.7%（-114.12美元/16285.85美元）。治疗费用的大幅增加是由于接受治疗的病人比例增加。然而，改善的结果降低了其他每位患者的急性护理成本。在5年期间，先进的CTAP成像导致1.63%（66/4，040）的患者结局良好（90天mRS 0-2），2.23%（66/2，960）的患者结局较差（90天mRS 3-5），死亡率无变化（90天mRS 6）。我们的CT设备利用率分析显示，与标准治疗策略相比，高级CTAP成像策略中对CT设备的扫描时间（分钟）需求降低了24%。在CSC进行的EVT手术数量可能增加50%。结论：我们的研究表明，与标准治疗成像相比，采用先进的CTAP成像增加了急性缺血性卒中患者的治疗需求，因为更多的患者在治疗时间窗内被诊断出来。先进的成像技术还可以使更多的患者获得良好的功能结局，减少依赖性功能状态的患者。
Introduction: The purpose of this study was to illustrate the potential costs and health consequences of implementing advanced CT angiography and perfusion (CTAP) as the initial imaging in patients presenting with acute ischemic stroke (AIS) symptoms at a comprehensive stroke center (CSC). Methods: A decision-simulation model based on the American Heart Association's recommendations for AIS care pathways was developed to assess imaging strategies for a 5-year period from the institutional perspective. The following strategies were compared: (1) advanced CTAP imaging: NCCT + CTA + CT perfusion at the time of presentation; (2) standard-of-care: non-contrast CT (NCCT) at the time of presentation, with CT angiography (CTA) ± CT perfusion only in select patients (initial imaging to exclude hemorrhage and extensive ischemia) for mechanical thrombectomy (MT) evaluation. Model parameters were defined with evidence-based data. Cost-consequence and sensitivity analyses were performed. The modified Rankin Scale (mRS) at 90 days was used as the outcome measure. Results: The decision-simulation modeling revealed that adoption of the advanced CTAP imaging increased per-patient imaging costs by 1.19% ($9.28/$779.72), increased per-patient treatment costs by 33.25% ($729.96/$2,195.24), and decreased other per-patient acute care costs by 0.7% (–$114.12/$16,285.85). The large increase in treatment costs was caused by higher proportion of patients being treated. However, improved outcomes lowered the other per-patient acute care costs. Over the five-year period, advanced CTAP imaging led to 1.63% (66/4,040) more patients with good outcomes (90-day mRS 0-2), 2.23% (66/2,960) fewer patients with poor outcomes (90-day mRS 3-5), and no change in mortality (90-day mRS 6). Our CT equipment utilization analysis showed that the demand for CT equipment in terms of scanner time (minutes) was 24% lower in the advanced CTAP imaging strategy compared to the standard-of-care strategy. The number of EVT procedures performed at the CSC may increase by 50%. Conclusions: Our study reveals that adoption of advanced CTAP imaging at presentation increases the demand for treatment of acute ischemic stroke patients as more patients are diagnosed within the treatment time window compared to standard-of-care imaging. Advanced imaging also leads to more patients with good functional outcomes and fewer patients with dependent functional status.
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DOI：
10.1016/j.jacr.2020.12.013
发表时间：
2021-06
期刊：
Journal of the American College of Radiology : JACR
影响因子：
--
作者：
Martinez G;Katz JM;Pandya A;Wang JJ;Boltyenkov A;Malhotra A;Mushlin AI;Sanelli PC
通讯作者：
Sanelli PC
动脉内处理作为急性缺血性中风的静脉内组织型纤溶酶原激活剂的辅助性的成本效益。
影响因子：
8.3
作者：
Leppert MH;Campbell JD;Simpson JR;Burke JF
通讯作者：
Burke JF
影响因子：
8.3
作者：
Chaisinanunkul N;Adeoye O;Lewis RJ;Grotta JC;Broderick J;Jovin TG;Nogueira RG;Elm JJ;Graves T;Berry S;Lees KR;Barreto AD;Saver JL;DAWN Trial and MOST Trial Steering Committees;Additional contributors from DAWN Trial Steering Committee
通讯作者：
Additional contributors from DAWN Trial Steering Committee
影响因子：
120.7
作者：
Saver, Jeffrey L.;Fonarow, Gregg C.;Schwamm, Lee H.
通讯作者：
Schwamm, Lee H.
DOI：
10.1016/s1474-4422(14)70066-3
发表时间：
2014-06
期刊：
The Lancet. Neurology
影响因子：
--
作者：
Khatri P;Yeatts SD;Mazighi M;Broderick JP;Liebeskind DS;Demchuk AM;Amarenco P;Carrozzella J;Spilker J;Foster LD;Goyal M;Hill MD;Palesch YY;Jauch EC;Haley EC;Vagal A;Tomsick TA;IMS III Trialists
通讯作者：
IMS III Trialists