دورية أكاديمية
Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment:a model-based health economic evaluation study
| العنوان: | Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment:a model-based health economic evaluation study |
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| المؤلفون: | van Voorst, Henk, Hoving, Jan W., Koopman, Miou S., Daems, Jasper D., Peerlings, Daan, Buskens, Erik, Lingsma, Hester F., Beenen, Ludo F. M., de Jong, Hugo W. A. M., Berkhemer, Olvert A., van Zwam, Wim H., Roos, Yvo B. W. E. M., van Walderveen, Marianne A. A., van den Wijngaard, Ido, Dippel, Diederik W. J., Yoo, Albert J., Campbell, Bruce C. V., Kunz, Wolfgang G., Emmer, Bart J., Majoie, Charles B. L. M. |
| المصدر: | van Voorst , H , Hoving , J W , Koopman , M S , Daems , J D , Peerlings , D , Buskens , E , Lingsma , H F , Beenen , L F M , de Jong , H W A M , Berkhemer , O A , van Zwam , W H , Roos , Y B W E M , van Walderveen , M A A , van den Wijngaard , I , Dippel , D W J , Yoo , A J , Campbell , B C V , Kunz , W .... |
| سنة النشر: | 2023 |
| الوصف: | Objectives: CT perfusion (CTP) has been suggested to increase the rate of large vessel occlusion (LVO) detection in patients suspected of acute ischemic stroke (AIS) if used in addition to a standard diagnostic imaging regime of CT angiography (CTA) and non-contrast CT (NCCT). The aim of this study was to estimate the costs and health effects of additional CTP for endovascular treatment (EVT)–eligible occlusion detection using model-based analyses. Methods: In this Dutch, nationwide retrospective cohort study with model-based health economic evaluation, data from 701 EVT-treated patients with available CTP results were included (January 2018–March 2022; trialregister.nl:NL7974). We compared a cohort undergoing NCCT, CTA, and CTP (NCCT + CTA + CTP) with a generated counterfactual where NCCT and CTA (NCCT + CTA) was used for LVO detection. The NCCT + CTA strategy was simulated using diagnostic accuracy values and EVT effects from the literature. A Markov model was used to simulate 10-year follow-up. We adopted a healthcare payer perspective for costs in euros and health gains in quality-adjusted life years (QALYs). The primary outcome was the net monetary benefit (NMB) at a willingness to pay of €80,000; secondary outcomes were the difference between LVO detection strategies in QALYs (ΔQALY) and costs (ΔCosts) per LVO patient. Results: We included 701 patients (median age: 72, IQR: [62–81]) years). Per LVO patient, CTP-based occlusion detection resulted in cost savings (ΔCosts median: € − 2671, IQR: [€ − 4721; € − 731]), a health gain (ΔQALY median: 0.073, IQR: [0.044; 0.104]), and a positive NMB (median: €8436, IQR: [5565; 11,876]) per LVO patient. Conclusion: CTP-based screening of suspected stroke patients for an endovascular treatment eligible large vessel occlusion was cost-effective. Clinical relevance statement.: Although CTP-based patient selection for endovascular treatment has been recently suggested to result in worse patient outcomes after ischemic stroke, an alternative CTP-based screening for ... |
| نوع الوثيقة: | article in journal/newspaper |
| اللغة: | English |
| العلاقة: | https://research.vumc.nl/en/publications/196e9dfd-4c9e-44d1-87c9-7eb587c5ecf6Test |
| DOI: | 10.1007/s00330-023-10119-y |
| الإتاحة: | https://doi.org/10.1007/s00330-023-10119-yTest https://research.vumc.nl/en/publications/196e9dfd-4c9e-44d1-87c9-7eb587c5ecf6Test http://www.scopus.com/inward/record.url?scp=85171598701&partnerID=8YFLogxKTest |
| حقوق: | info:eu-repo/semantics/openAccess |
| رقم الانضمام: | edsbas.4472222A |
| قاعدة البيانات: | BASE |
| DOI: | 10.1007/s00330-023-10119-y |
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