Table 1. List of Input Parametersa.
| Model input parameters | Base-case value | Distribution | Range | Source |
|---|---|---|---|---|
| 3-Monthly transition probabilities in the Markov model | ||||
| State after recurrence of a patient in mRS 0 | Fagan et al9,10 for probability of death and assumption that patient has an equal risk of transitioning to 1 of the worse states | |||
| mRS 1 | 0.19 | Dirichlet | 0-1 | |
| mRS 2 | 0.19 | |||
| mRS 3 | 0.19 | |||
| mRS 4 | 0.19 | |||
| mRS 5 | 0.19 | |||
| mRS 6 or death | 0.0513 | |||
| State after recurrence of a patient in mRS 1 | ||||
| mRS 2 | 0.24 | Dirichlet | 0-1 | |
| mRS 3 | 0.24 | |||
| mRS 4 | 0.24 | |||
| mRS 5 | 0.24 | |||
| mRS 6 or death | 0.0513 | |||
| State after recurrence of a patient in mRS 2 | ||||
| mRS 3 | 0.32 | Dirichlet | 0-1 | |
| mRS 4 | 0.32 | |||
| mRS 5 | 0.32 | |||
| mRS 6 or death | 0.0513 | |||
| State after recurrence of a patient in mRS 3 | ||||
| mRS 4 | 0.47 | Dirichlet | 0-1 | |
| mRS 5 | 0.47 | |||
| mRS 6 or death | 0.0513 | |||
| State after recurrence of a patient in mRS 4 | β | Parameters, α = 94.9; β = 5.1 | ||
| mRS 5 | 0.95 | |||
| mRS 6 or death | 0.0513 | |||
| Death hazard ratios | ||||
| mRS 0 | 1 | Log normal | SE, 0.076 | Samsa et al,8 1999 |
| mRS 1 | 1 | SE, 0.46 | ||
| mRS 2 | 1.11 | SE, 0.46 | ||
| mRS 3 | 1.27 | SE, 0.46 | ||
| mRS 4 | 1.71 | SE, 0.46 | ||
| mRS 5 | 2.37 | SE, 0.46 | ||
| Recurrence | 0.013 | β | Parameters, α = 13; β = 986 | Ganesalingam et al,11 2015 |
| Costs and resource use | ||||
| Costs and resource use in the decision tree | ||||
| CT | $198 | β Pert | $168-$228 | CMS,12 2015 |
| CTA | $774 | β Pert | $658-$890 | |
| MRI | $625 | β Pert | $531-$718 | |
| MRA | $1023 | β Pert | $870-$1176 | |
| CTP | $836 | β Pert | $711-$961 | Jackson et al,13 2010 |
| Software | $89 | β Pert | $44-$520 | eTable 3 in the Supplement |
| Frequency of CTA vs MRA | 0.5 | Uniform | 0-1 | Assumed |
| Frequency of CTP vs MRI | 0.5 | Uniform | 0-1 | |
| IV-tPA acquisition and administration | $8004 | β Pert | $6403-$9605 | Kunz et al,14 2016 |
| MT devices, nonphysician room personnel, and operating room overhead | $15 836 | β Pert | $5270-$26 401 | Shireman et al,15 2017 |
| Physician costs | $2749 | β Pert | $1262-$4236 | |
| Acute first 3-mo costs | ||||
| mRS 0 | $14 382 | β Pert | $14 210-$14 554 | Joo et al,16 2017; no IV-tPA group, weighted mean of costs for the group aged 65-80 y and the group aged ≥80 y |
| mRS 1 | $14 382 | β Pert | $14 210-$14 554 | |
| mRS 2 | $14 382 | β Pert | $14 210-$14 554 | |
| mRS 3 | $17 879 | β Pert | $17 660-$18 097 | |
| mRS 4 | $17 879 | β Pert | $17 660-$18 097 | |
| mRS 5 | $17 879 | β Pert | $17 660-$18 097 | |
| mRS 6 or death | $23 498 | β Pert | $22 614-$24 382 | |
| Costs and resource use in the Markov model | ||||
| 3-monthly long-term health care costs, day 90 onward | ||||
| mRS 0 | $2836 | β Pert | $2269-$3403 | Shireman et al,15 2017; Earnshaw et al,17 2009, for range |
| mRS 1 | $2741 | β Pert | $2336-$3504 | |
| mRS 2 | $3378 | β Pert | $2703-$4054 | |
| mRS 3 | $5801 | β Pert | $4641-$6961 | |
| mRS 4 | $11 742 | β Pert | $9393-$14 090 | |
| mRS 5 | $17 262 | β Pert | $13 809-$20 714 | |
| Cost of recurrent stroke 90 d following stroke recurrence | Values for the total population | No independent distribution was defined; costs vary based on the 2000 PSA results (ie, expected value of costs) of decision tree | Based on the 95% CIs of the 2000 PSA results | From short-run 90-d decision tree |
| MT with SMC strategy | ||||
| DAWN trial | $37 974 | $29 607-$47 008 | ||
| DEFUSE 3 trial | $38 500 | $30 077-$47 738 | ||
| SMC alone strategy | ||||
| DAWN trial | $20 693 | $20 073-$21 378 | ||
| DEFUSE 3 trial | $20 479 | $19 834-$21 198 | ||
| Utilities | ||||
| mRS 0 | 0.85 | β | 0.80-1.00 | Gage et al,18 1998; Nelson et al,19 2016; Earnshaw et al,17 2009, for the range. |
| mRS 1 | 0.80 | β | 0.80-0.95 | |
| mRS 2 | 0.70 | β | 0.68-0.90 | |
| mRS 3 | 0.51 | β | 0.45-0.65 | |
| mRS 4 | 0.30 | β | 0.10-0.40 | |
| mRS 5 | 0.15 | β | 0-0.32 | |
| mRS 6 or death | 0 | NA | NA | |
| Recurrent stroke 90 d following stroke recurrence | Values for the total population | No independent distribution was defined; utilities vary based on the 2000 PSA results (ie, expected value of utility) of the decision tree | Based on the 95% CI of the 2000 runs | From short-run 90-d decision-tree |
| MT with SMC strategy | ||||
| DAWN trial | 0.49 | 0.43-0.56 | ||
| DEFUSE 3 trial | 0.48 | 0.42-0.56 | ||
| SMC alone strategy | ||||
| DAWN trial | 0.31 | 0.24-0.37 | ||
| DEFUSE 3 trial | 0.31 | 0.24-0.37 | ||
Abbreviations: CT, computed tomography; CTA, CT angiography; CTP, CT perfusion; IV-tPA, intravenous tissue plasminogen activator; MRA, magnetic resonance angiography; MRI, MR imaging; mRS, modified Ranking Scale; MT, mechanical thrombectomy; SMC, standard medical care.
a
Input parameters related to efficacy of MT with SMC and SMC alone, used in the decision tree, can be found in eTable 1 in the Supplement.