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| Journal of stroke. 2022 Jan 31. pii: jos.2021.01606. doi: 10.5853/jos.2021.01606 |
| Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study. |
| Kunz WG1, Sporns PB2, Psychogios MN3, Fiehler J4, Chapot R5, Dorn F6, Grams A7, Morotti A8, Musolino P9, Lee S10, Kemmling A11, Henkes H12, Nikoubashman O13, Wiesmann M14, Jensen-Kondering U15, Möhlenbruch M16, Schlamann M17, Marik W18, Schob S19, Wendl C20, Turowski B21, Götz F22, Kaiser D23, Dimitriadis K24, Gersing A25, Liebig T26, Ricke J27, Reidler P28, Wildgruber M29, Mönch S30 |
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Abstract BACKGROUND AND PURPOSE: The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population. METHODS: In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY. RESULTS: yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives. CONCLUSIONS: EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke. |
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KEYWORDS: Cost-benefit analysis, Pediatrics, Stroke, Thrombectomy |
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Publikations ID: 35135067 Quelle: öffnen |
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