Mechanical thrombectomy for acute ischemic stroke due to large vessel occlusion in Argentina: An economic analysis

OBJECTIVES

Mechanical thrombectomy (MT) after intravenous thrombolysis (IV-tPA) is an effective and cost-saving treatment for stroke due to large vessel occlusion. However, rates of MT use are low in Argentina. This study was designed to estimate the economic value and the budget impact of incorporating MT after thrombolysis, simulating scenarios from Argentinian compulsory social health insurance (Obras Sociales) and private insurances (Empresas de Medicina Prepaga).

MATERIALS AND METHODS

We adapted a previously published cost-utility and budget-impact (CUA and BIA) model to the Argentinian setting. The CUA was carried out for a lifetime horizon with efficacy inputs from the SWIFT PRIME clinical trial. For seven possible health states, we identified local costs (Argentinian Pesos AR$), utility (QALY), and transition/distribution probabilities (5% discounted rate) and performed deterministic and probabilistic sensitivity analyses. The BIA was based on a six-step approach and a static model for a five-year horizon, and two scenarios (staggered growth and no growth).

RESULTS

Despite higher incremental procedure costs, IV-tPA and MT was dominant over IV-tPA alone (AR$1,049,062 overall savings). Cost-effectiveness remained in the deterministic sensitivity analysis (100% probability of cost-effectiveness). Increased MT procedure volume resulted in savings in years three (0.96%), four (2.6%), and five (4.4%). By year five, 1,280 patients were treated with MT (versus 480) with overall savings of 1.8% (AR$817,244,417).

CONCLUSIONS

MT after IV-tPA is cost-effective in Argentina. Savings offset the incremental hospitalization and long-term costs from the third year onwards. With increased, access the superior efficacy of MT mitigates future disability and comorbidity, reducing overall expenses.

[Obstetric anesthesia-analgesia in Spain. A review of its historic evolution during the second half of the past century]

To examine the historical development of obstetric anesthesia in Spain during the second half of the nineteenth century. Research was based on in-depth analysis of accounts of anesthesia during the period covered, mainly from original sources, using established methods for studying the history of medicine. We collected a great deal of documentary evidence, much of it unpublished and of clear historical value for tracing the history of obstetric anesthesia in Spain and identifying the main factors that have influenced it. We emphasize that controversy limited to a large extent the use of anesthesia in obstetrics. The controversy seems to have been fed by physicians' uneasiness with anesthesia as well as by certain prejudices of a religious or moral nature that are deeply rooted in Spanish society.