Table 9:
Results of Economic Literature Review—Summary
| Name, Year | Study Design and Perspective | Population | Interventions Comparators | Results | ||
|---|---|---|---|---|---|---|
| Health Outcomes | Costs | Cost-Effectiveness | ||||
| Leppert et al, 201537 | Type of analysis: CUA Study design: decision-analytic model Perspective: payer, United States Time horizon: lifetime |
Adults with an acute large-artery ischemic stroke; see MR CLEAN study for details38 | IV tPA IV tPA plus MT |
QALY gained: 0.70 Total QALYs: 3.10 (IV tPA); 3.80 (IV tPA plus MT) Annual discount rate: 3% |
Cost year: 2012 Incremental cost: $9,911 USD Total costs: $130,144 USD (IV tPA); $140,055 USD (IV tPA plus MT) Annual discount rate: 3% |
ICER: $14,137 USD per QALY gained |
| Bouvy et al, 201333 | Type of analysis: CUA Study design: decision-analytic model Perspective: health sector, Netherlands Time horizon: lifetime |
Patients with a clinical diagnosis of ischemic stroke, and no contraindications for IVT or MT | Medical therapy IVT IA thrombolysisa IV-IA thrombolysis |
QALY gained: 0.28 (IA thrombolysis vs. medical therapy); 0.11 (IV-IA thrombolysis vs. IVT) Total QALYs: 3.39 (medical therapy); 3.61 (IVT); 3.67 (IA thrombolysis); 3.72 (IV-IA thrombolysis) Annual discount rate: 3% |
Cost year: 2010 Incremental cost: –€1,983 (IA thrombolysis vs. medical therapy); €222 (IV-IA thrombolysis vs. IVT) Total costs: €34,182 (medical therapy); €32,113 (IVT); €32,199 (IA thrombolysis); €32,335 (IV-IA thrombolysis) Annual discount rate: 3% |
ICER: dominant (IA thrombolysis vs. medical therapy); €1,922 per QALY gained (IV-IA thrombolysis vs. IVT) |
| Nguyen-Huynh et al, 201134 | Type of analysis: CUA Study design: decision-analytic model Perspective: society, United States Time horizon: lifetime |
65-year-old men or women with acute ischemic stroke and an occlusion of a major intracranial artery, but not eligible for IV tPA | Best medical therapy Neurointerventional radiology, typically MT |
QALY gained: 0.82 Total QALYs: NA Annual discount rate: 3% |
Cost year: 2009 Incremental cost: $7,718 USD Total costs: NA Annual discount rate: 3% |
ICER: $9,386 USD per QALY gained |
| Kim et al, 201135 | Type of analysis: CUA Study design: decision-analytic model Perspective: payer, United States Time horizon: lifetime |
Hypothetical 68-year-old patient with an acute large-artery ischemic stroke who was eligible for IV tPA | IV tPA IV tPA plus MT |
QALY gained: 0.68 Total QALYs: NA Annual discount rate: 3% |
Cost year: 2009 Incremental cost: $10,840 USD Total costs: NA Annual discount rate: 3% |
ICER: $16,001 USD per QALY gained |
| Patil et al, 200936 | Type of analysis: CUA Study design: decision-analytic model Perspective: payer, United States Time horizon: 20 years |
Hypothetical 67-year-old patient with a large-artery ischemic stroke who was ineligible for IV tPA | Best medical therapy MT | QALY gained: 0.54 Total QALYs: 1.83 (best medical therapy); 2.37 (MT) Annual discount rate: 3% |
Cost year: 2008 Incremental cost: $6,600 USD Total costs: $142,000 USD (best medical therapy); $148,600 USD (MT) Annual discount rate: 3% |
ICER: $12,120 USD per QALY gained |
Abbreviations: CUA, cost-utility analysis; IA, intra-arterial; ICER, incremental cost-effectiveness ratio; IV, intravenous; IVT, intravenous thrombolysis; IV tPA, intravenous tissue plasminogen activator; MT, mechanical thrombectomy; NA, not applicable; QALY, quality-adjusted life-year.
a
50% of patients underwent treatment using a retrievable stent.