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Nguyen CP, Lahr MMH, van der Zee DJ, van Voorst H, Ribo M, Roos YBWM, van den Wijngaard I, Buskens E, Uyttenboogaart M. Cost-effectiveness of Direct Transfer to Angiography Suite of Patients With Suspected Large Vessel Occlusion. Neurology 2023; 101:e1036-e1045. [PMID: 37438129 PMCID: PMC10491438 DOI: 10.1212/wnl.0000000000207583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/10/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with acute ischemic stroke due to large vessel occlusion (LVO) deemed eligible for endovascular thrombectomy (EVT) are transferred from the emergency room to the angiography suite to undergo the procedure. Recently, the strategy of direct transfer of patients with suspected LVO to the angiography suite (DTAS) has been shown to improve functional outcomes. This study aims to evaluate the cost-effectiveness of the DTAS strategy vs initial transfer of patients with suspected LVO (Rapid Arterial Occlusion Evaluation score >4 and NIH Stroke Scale >10) to the emergency room (ITER). METHODS A decision-analytic Markov model was developed to estimate the cost-effectiveness of the DTAS strategy vs the ITER strategy from a Dutch health care perspective with a 10-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER) using Dutch thresholds of $59,135 (€50,000) and $94,616 (€80,000) per quality-adjusted life year (QALY). Uncertainty of input parameters was assessed using 1-way sensitivity analysis, scenario analysis, and probabilistic sensitivity analysis. RESULTS The DTAS strategy yielded 0.65 additional QALYs at an additional $16,089, resulting in an ICER of $24,925/QALY compared with the ITER strategy. The ICER varied from $27,169 to $38,325/QALY across different scenarios. The probabilistic sensitivity analysis showed that the DTAS strategy had a 91.8% and 97.0% likelihood of being cost-effective at a decision threshold of $59,135/QALY and $94,616/QALY, respectively. DISCUSSION The cost-effectiveness of the DTAS strategy over ITER is robust for patients with suspected LVO. Together with recently published clinical results, this means that implementation of the DTAS strategy may be considered to improve the workflow and outcome of EVT.
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Affiliation(s)
- Chi P Nguyen
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center.
| | - Maarten M H Lahr
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Durk-Jouke van der Zee
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Henk van Voorst
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Marc Ribo
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Yvo B W M Roos
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Ido van den Wijngaard
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Erik Buskens
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
| | - Maarten Uyttenboogaart
- From the Department of Operations (C.P.N., D.-J.v.d.Z., E.B.), Faculty of Economics and Business, University of Groningen; Health Technology Assessment (C.P.N., M.M.H.L., D.-J.v.d.Z., E.B.), Department of Epidemiology, and Departments of Neurology (M.U.), and Radiology, Medical Imaging Center (M.U.), University of Groningen, University Medical Center Groningen, the Netherlands; Department of Pharmaceutical Administration and Economics (C.P.N.), Hanoi University of Pharmacy, Vietnam; Departments of Radiology and Nuclear Medicine (H.v.V.), Biomedical Engineering and Physics (H.v.V.), and Neurology (Y.B.W.M.R.), Amsterdam University Medical Center, the Netherlands; Unitat d'Ictus (M.R.), Servei de Neurologia, Hospital Universitari Vall d'Hebron, Spain; Department of Neurology (I.v.d.W.), Haaglanden Medical Center; and Department of Neurology (I.v.d.W.), Leiden University Medical Center
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