| Title: |
Costs and health effects of CT perfusion-based selection for endovascular thrombectomy within 6 hours of stroke onset: a model-based health economic evaluation |
| Authors: |
van Voorst, Henk; Hoving, Jan W; Koopman, Miou S; Daems, Jasper D; Peerlings, Daan; Buskens, Erik; Lingsma, Hester; Marquering, Henk A; de Jong, Hugo W A M; Berkhemer, Olvert A; van Zwam, Wim H; van Walderveen, Marianne A A; van den Wijngaard, Ido R; Dippel, Diederik W J; Yoo, Albert J; Campbell, Bruce; Kunz, Wolfgang G; Majoie, Charles B; Emmer, Bart J; CLEOPATRA; MR CLEAN Registry; CONTRAST Consortium Investigators; Dippel, Diederik; Majoie, Charles; Nuland, Rick van; Lugt, Aad van der; Es, Adriaan van; Doormaal, Pieter-Jan van; Berg, Renévan den; Beenen, Ludo; Emmer, Bart; Roosendaal, Stefan; Zwam, Wim van; Postma, Alida Annechien; Yo, Lonneke; Krietemeijer, Menno; Lycklama, Geert; Martens, Jasper; Hammer, Sebastiaan; Meijer, Anton; Bokkers, Reinoud; Hoorn, Anouk van der; Wijngaard, Ido van den; Yoo, Albert; Gerrits, Dick; Oostenbrugge, Robert van; Coutinho, Jonathan M.; Truijman, Martine; Staals, Julie; Worp, Bart van der; Boogaarts, J.; Ben Jansen, Sanne Zinkstok; Roos, Yvo; Koudstaal, Peter; Keizer, Koos; Manschot, Sanne; Boiten, Jelis; Kerkhoff, Henk; Chalos, Vicky; Berkhemer, Olvert; Versteeg, Adriaan; Wolff, Lennard; Sluijs, Matthijs van der; Voorst, Henk van; Tolhuisen, Manon; Cate, Hugo ten; Maat, Moniek de; Donse-Donkel, Samantha; Beusekom, Heleen van; Taha, Aladdin; Barakzie, Aarazo; Graaf, Rob van de; Steen, Wouter van der; Treurniet, Kilian; Berg, Sophie van den; LeCouffe, Natalie; Kappelhof, Manon; Reinink, Rik; Rinkel, Leon; Brouwer, Josje; Bruggeman, Agnetha; Goldhoorn, Robert-Jan; Hinsenveld, Wouter; Pirson, Anne; Olthuis, Susan; Venema, Simone Uniken; Teeselink, Sjan; Sondag, Lotte; Collette, Sabine; Sterrenberg, Martin; Ghannouti, Naziha El; Steen, Laurine van der; Verheesen, Sabrina; Vranken, Jeannique; Ahee, Ayla van; Bongenaar, Hester; Smallegange, Maylee; Tilet, Lida; Meris, Joke de; Simons, Michelle; Pellikaan, Wilma; Wijngaarden, Wilma van; Blauwendraat, Kitty; Drabbe, Yvonne; Sandiman-Lefeber, Michelle; Katthöfer, Anke; Ponjee, Eva; Eilander, Rieke; Loon, Anja van; Kraus, Karin; Kooij, Suze; Slotboom, Annemarie; Jong, Marieke de; Minne, Friedus van der; Santegoets, Esther; Sprengers, Rita; Heiligers, Leontien; Martens, Yvonne; Dippel, Diederik W.J.; Majoie, Charles B.L.M.; Roos, Yvo B.W.E.M.; van Oostenbrugge, Robert J.; van Zwam, Wim H.; Vos, Jan Albert; Jansen, Ivo G.H.; Mulder, Maxim J.H.L.; Goldhoorn, Robert- Jan B.; Compagne, Kars C.J.; den Hartog, Sanne J.; Hinsenveld, Wouter H.; Heuve, Lotte van den; Roozenbeek, Bob; Doormaal, Pieter Jan van; Emmer, Bart J.; Schonewille, Wouter J.; Wermer, Marieke J.H.; van Walderveen, Marianne A.A.; Adriaan, C.G.M; Es, van; Hofmeijer, Jeannette; Martens, Jasper M.; de Bruijn, Sebastiaan F.; Lukas, C; van Dijk, H; Lo, Rob H.; van Dijk, Ewoud J.; Boogaarts, Hieronymus D.; de Vries, J.; de Kort, Paul L.M.; Tuijl, Julia van; Boukrab, Issam; Peluso, Jo P.; Fransen, Puck; van den Berg, Jan S.P.; den Hertog, Heleen M.; van Hasselt, Boudewijn A.A.M.; Aerden, Leo A.M.; Dallinga, RenéJ.; Uyttenboogaart, Maarten; Eschgi, Omid; Bokkers, Reinoud P.H.; Schreuder, Tobien H.C.M.L.; Heijboer, Roel J.J.; Gons, Rob A.R.; Yo, Lonneke S.F.; Sturm, Emiel J.C.; Bulut, Tomas; Brouwers, Paul J.A.M.; Rozeman, Anouk D.; Elgersma, Otto; Remmers, Michel J.M.; de Jong, Thijs E.A.M.; Sprengers, Marieke E.S.; Jenniskens, Sjoerd F.M.; Yoo, Albert J.; Beenen, Ludo F.M.; Postma, Alida A.; Roosendaal, Stefan D.; van der Kallen, Bas F.W.; van den Wijngaard, Ido R.; Bot, Joost; Ghariq, Elyas; Marc, P; van Proosdij, G; Lo, Rob; Dinkelaar, Wouter; Appelman, Auke P.A.; Hammer, Bas; Pegge, Sjoert; Vinke, Saman; Cornelissen, Sandra; Leij, Christiaan van der; Brans, Rutger; Bakker, Jeanette; Koopman, Miou; Smagge, Lucas; Berkhemer, Olvert A.; Markenstein, Jeroen; Hendriks, Eef; Brouwer, Patrick; Zwenneke Flach, H.; Lingsma, Hester F.; Ghannouti, Naziha el; Elfrink, Marjan; Vossers, Marjolein; Vermeulen, Tamara; Geerlings, Annet; Vemde, Gina van; Simons, Tiny; Messchendorp, Gert; Nicolaij, Nynke; Bodde, Karin; Kleijn, Sandra; Lodico, Jasmijn; Droste, Hanneke; Wollaert, Maureen; Jeurrissen, D.; Bos, Erna; Sandiman, Michelle; Aaldering, Nicoline; Zweedijk, Berber; Vervoort, Jocova; Romviel, Sharon; Kanselaar, Karin; Barning, Denn; Venema, Esmee; Geuskens, Ralph R.; Straaten, Tim van; Ergezen, Saliha; Harmsma, Roger R.M.; Muijres, Daan; Jong, Anouk de; Boers, Anna M.M.; Huguet, J.; Groot, P.F.C.; Mens, Marieke A.; van Kranendonk, Katinka R.; Treurniet, Kilian M.; Tolhuisen, Manon L.; Alves, Heitor; Weterings, Annick J.; Kirkels, Eleonora L.F.; Voogd, Eva J.H.F.; Schupp, Lieve M.; Collette, Sabine L.; Groot, Adrien E.D.; LeCouffe, Natalie E.; Konduri, Praneeta R.; Prasetya, Haryadi; Arrarte-Terreros, Nerea; Ramos, Lucas A.; Boodt, Nikki; Pirson, Anne F.A.V; Bruggeman, Agnetha A.E.; van der Ende, Nadinda A.M.; Deniz, Rabia; Olthuis, Susanne G.H.; Pinckaers, Floor; Lycklama àNijeholt, Geert J.; Marquering, Henk; Jong, Hugo de; Hoving, Arnolt-Jan; Daems, Jasper; Coutinho, Jonathan; Dankbaar, Jan Willem; Hofmeijer, Jeanette; Walderveen, Marianne van; Wermer, Marieke; Gons, Rob; Ridder, Inger de; Laat, Karlijn de; Dijk, Lukas van; Bruijn, Sebastiaan de; Kort, Paul de; Remmers, Michel; Norden, Anouk van; Kortman, Hans; Schreuder, Floris; Dijk, Ewoud van; Boogaarts, Hieronymus; Hertog, Heleen den; Flach, Zwenneke; Berg, Jan van den; Hasselt, Boudewijn van; Imani, Farshad; Rozeman, Anouk; Brouwers, Paul; Bulut, Thomas; Schonewille, Wouter; Kunz, Wolfgang; Pannekoek, Nienke; Jacobi, Linda; Sprengers, Marieke; Jenniskens, Sjoer; Postma, Alida; Kallen, Bas van der; Appelman, Auke; Su, Jiahang; Geuskens, Ralph; Harmsma, Roger; Boers, Merel; Groot, Paul; Mens, Marieke; Kranendonk, Katinka van; Weterings, Annick; Kirkels, Eleonora; Voogd, Eva; Schupp, Lieve; Groot, Adrien; Konduri, Praneeta; Terreros, Nerea Arrarte; Ramos, Lucas; Ende, Nadinda van der; Wouters, Anke; Lycklama àNijeholt, Geert |
| Publisher Information: |
BMJ Publishing Group Ltd |
| Publication Year: |
2024 |
| Collection: |
HighWire Press (Stanford University) |
| Subject Terms: |
Cerebrovascular disease |
| Description: |
Background Although CT perfusion (CTP) is often incorporated in acute stroke workflows, it remains largely unclear what the associated costs and health implications are in the long run of CTP-based patient selection for endovascular treatment (EVT) in patients presenting within 6 hours after symptom onset with a large vessel occlusion. Methods Patients with a large vessel occlusion were included from a Dutch nationwide cohort (n=703) if CTP imaging was performed before EVT within 6 hours after stroke onset. Simulated cost and health effects during 5 and 10 years follow-up were compared between CTP based patient selection for EVT and providing EVT to all patients. Outcome measures were the net monetary benefit at a willingness-to-pay of €80 000 per quality-adjusted life year, incremental cost-effectiveness ratio), difference in costs from a healthcare payer perspective (ΔCosts) and quality-adjusted life years (ΔQALY) per 1000 patients for 1000 model iterations as outcomes. Results Compared with treating all patients, CTP-based selection for EVT at the optimised ischaemic core volume (ICV≥110 mL) or core-penumbra mismatch ratio (MMR≤1.4) thresholds resulted in losses of health (median ΔQALYs for ICV≥110 mL: −3.3 (IQR: −5.9 to −1.1), for MMR≤1.4: 0.0 (IQR: −1.3 to 0.0)) with median ΔCosts for ICV≥110 mL of −€348 966 (IQR: −€712 406 to −€51 158) and for MMR≤1.4 of €266 513 (IQR: €229 403 to €380 110)) per 1000 patients. Sensitivity analyses did not yield any scenarios for CTP-based selection of patients for EVT that were cost-effective for improving health, including patients aged ≥80 years Conclusion In EVT-eligible patients presenting within 6 hours after symptom onset, excluding patients based on CTP parameters was not cost-effective and could potentially harm patients. |
| Document Type: |
text |
| File Description: |
text/html |
| Language: |
English |
| Relation: |
http://jnnp.bmj.com/cgi/content/short/95/6/515; http://dx.doi.org/10.1136/jnnp-2023-331862 |
| DOI: |
10.1136/jnnp-2023-331862 |
| Availability: |
http://jnnp.bmj.com/cgi/content/short/95/6/515; https://doi.org/10.1136/jnnp-2023-331862 |
| Rights: |
Copyright (C) 2024, BMJ Publishing Group Ltd |
| Accession Number: |
edsbas.A9D2D6B7 |
| Database: |
BASE |