Cost-Effectiveness of Intra-Arterial Treatment as an Adjunct to Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke.
Cost-Effectiveness of Intra-Arterial Treatment as an Adjunct to Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke.
复制标题
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。
DOI：
10.1161/strokeaha.115.009779
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发表时间：
2015-07
期刊：
影响因子：
8.3
通讯作者：
Burke JF
中科院分区：
文献类型：
--
作者：
Leppert MH;Campbell JD;Simpson JR;Burke JF
这项研究的目的是在美国环境下从社会角度确定静脉注射组织型纤溶酶原激活剂(TPA)后0至6小时内动脉内治疗的成本效益与单独静脉注射tPA相比的成本效益。一个决策分析模型估计了与单独静脉注射tPA的标准治疗相比，动脉内治疗带来的额外好处相关的终生成本和结果。模型输入来自已发表的文献、MR CLEAN研究和美国的索赔数据库。健康结果以质量调整寿命年(QALY)衡量。通过计算每获得QALY的成本来评估治疗效益。进行了单向和概率敏感性分析，以估计模型结果的总体不确定性。与单独的标准治疗相比，动脉内治疗增加了0.7QALY，增加了9911美元的额外成本，导致每个QALY的成本为14137美元。多变量敏感性分析预测了97.6%的模拟运行的成本效益(每QALY的≤为50,000美元)。对于在6小时内发生前循环卒中的患者，静脉注射tPA后的动脉内治疗可能具有成本效益。从社会角度来看，增加对急性卒中动脉内治疗的投资可能是合理的。
The objective of this study was to determine the cost-effectiveness of intraarterial treatment within the 0- to 6- hour window after intravenous (IV) tissue plasminogen activator (tPA) within 0- to 4.5-hours compared to IV tPA alone, in the US setting and from a social perspective. A decision analytic model estimated the lifetime costs and outcomes associated with the additional benefit of intraarterial therapy compared to standard treatment with IV tPA alone. Model inputs were obtained from published literature, the MR CLEAN study, and claims databases in the United States. Health outcomes were measured in quality adjusted life years (QALYs). Treatment benefit was assessed by calculating the cost per QALY gained. One-way and probabilistic sensitivity analyses were performed to estimate the overall uncertainty of model results. The addition of intraarterial therapy compared with standard treatment alone yielded a lifetime gain of 0.7 QALY for an additional cost of $9,911, which resulted in a cost of $14,137 per QALY. Multivariable sensitivity analysis predicted cost-effectiveness (≤$50,000 per QALY) in 97.6% of simulation runs. Intraarterial treatment after IV tPA for patients with anterior circulation strokes within the 6 hour window is likely cost effective. From a societal perspective, increased investment in access to intraarterial treatment for acute stroke may be justified.