Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke
Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke
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急性缺血性脑卒中患者驱动与检索系统配置神经介入治疗的成本效益分析
DOI：
10.1016/j.jstrokecerebrovasdis.2021.105843
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发表时间：
2021
影响因子：
2.5
通讯作者：
Ogasawara Katsuhiko
中科院分区：
文献类型：
--
作者：
Morii Yasuhiro;Osanai Toshiya;Fujiwara Kensuke;Tanikawa Takumi;Houkin Kiyohiro;Gu Songzi;Ogasawara Katsuhiko
目的由于时间和资源限制（如血管内血栓切除术专家），血管内血栓切除术的实施率存在地区差异。在日本的北海道，Drive and Surveillance System（DRS）的血管内血栓切除术专家通过从他们通常工作的机构前往离患者较近的机构进行早期血管内血栓切除术。本研究分析了为DRS分配血管内血栓切除术专家治疗中风患者的成本效益。材料和方法估计了2015年北海道预计接受血管内血栓切除术的缺血性中风患者人数。假设为DRS分配了额外的中性介入医生。从政府的角度进行分析，包括医疗和护理成本以及血管内血栓切除术专家的人员成本。该分析比较了当前情况（患者在血管内血栓切除术专家通常工作的机构接受血管内血栓切除术）与DRS在60分钟车程内的情况。使用地理信息系统分析患者转运时间，并根据转运时间估计患者严重程度。主要结局是每个医疗领域的增量成本-效果比（ICER），其根据增量成本和增量质量调整生命年（QER）计算，使用已发表文献根据患者严重程度估计。整个过程重复100 times.ResultsDRS是最具成本效益的Kamikawachubu地区，ICER为14,173 ±16,802/QALY，显着低于阈值，日本guidelinesuspended.ConclusionsSince DRS是具有成本效益的Kamikawachubu地区，该地区应优先血管内血栓切除术专家DRS分配作为一项政策。
ObjectivesThere are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombectomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endovascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients.Materials and methodshe number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incremental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times.ResultsDRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173±16,802/QALY, significantly lower than the threshold that the Japanese guideline suggested.ConclusionsSince DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allocated as a policy.