Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke: Results From the SWIFT-PRIME Trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

被引：118

作者：

Shireman, Theresa I. ^{[1
]}

Wang, Kaijun ^{[2
]}

Saver, Jeffrey L. ^{[4
,5
]}

Goyal, Mayank ^{[7
,8
]}

Bonafe, Alain ^{[9
]}

Diener, Hans-Christoph ^{[10
]}

Levy, Elad I. ^{[11
]}

Pereira, Vitor M. ^{[12
,13
,14
]}

Albers, Gregory W. ^{[15
]}

Cognard, Christophe ^{[16
]}

Hacke, Werner ^{[17
]}

Jansen, Olav ^{[18
]}

Jovin, Tudor G. ^{[19
]}

Mattle, Heinrich P. ^{[20
]}

Nogueira, Raul G. ^{[21
]}

Siddiqui, Adnan H. ^{[22
]}

Yavagal, Dileep R. ^{[23
]}

Devlin, Thomas G. ^{[24
]}

Lopes, Demetrius K. ^{[25
]}

Reddy, Vivek K. ^{[19
]}

de Rochemont, Richard du Mesnil ^{[26
]}

Jahan, Reza ^{[6
]}

Vilain, Katherine A. ^{[2
]}

House, John ^{[2
]}

Lee, Jin-Moo ^{[27
]}

Cohen, David J. ^{[3
,28
]}

机构：

[1] Brown Univ, Sch Publ Hlth, Ctr Gerontol & Hlth Care Res, Providence, RI 02912 USA

[2] St Lukes Mid Amer Heart Inst, Dept Cardiovasc Res, Kansas City, MO USA

[3] St Lukes Mid Amer Heart Inst, Dept Cardiol, Kansas City, MO USA

[4] Univ Calif Los Angeles, Dept Neurol, Los Angeles, CA USA

[5] Univ Calif Los Angeles, Comprehens Stroke Ctr, Los Angeles, CA USA

[6] Univ Calif Los Angeles, Div Intervent Neuroradiol, Los Angeles, CA USA

[7] Univ Calgary, Dept Radiol, Calgary, AB, Canada

[8] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada

[9] Hop Gui de Chauliac, Dept Neuroradiol, Montpellier, France

[10] Univ Duisburg Essen, Univ Hosp, Dept Neurol, Duisburg, Germany

[11] SUNY Buffalo, Dept Neurosurg, Buffalo, NY USA

[12] Univ Toronto, Univ Hlth Network, Toronto Western Hosp, Dept Med Imaging,Div Neuroradiol, Toronto, ON, Canada

[13] Univ Toronto, Univ Hlth Network, Toronto Western Hosp, Dept Med Imaging,Div Neurosurg, Toronto, ON, Canada

[14] Univ Toronto, Univ Hlth Network, Toronto Western Hosp, Dept Surg, Toronto, ON, Canada

[15] Stanford Univ, Sch Med, Dept Neurol & Neurol Sci, Stanford, CA USA

[16] Univ Hosp Toulouse, Dept Diagnost & Therapeut Neuroradiol, Toulouse, France

[17] Heidelberg Univ, Dept Neurol, Heidelberg, Germany

[18] Univ Kiel, Dept Radiol & Neuroradiol, Kiel, Germany

[19] Univ Pittsburgh, Med Ctr, Dept Neurol, Pittsburgh, PA USA

[20] Univ Bern, Inselspital, Dept Neurol, Bern, Switzerland

[21] Emory Univ, Sch Med, Dept Neurol, Grady Mem Hosp,Marcus Stroke & Neurosci Ctr, Atlanta, GA USA

[22] SUNY Buffalo, Toshiba Stroke & Vasc Res Ctr, Dept Neurosurg, Buffalo, NY USA

[23] Univ Miami, Jackson Mem Hosp, Miller Sch Med, Dept Neurol & Neurosurg, Miami, FL 33136 USA

[24] Univ Tennessee, Erlanger Hosp, Div Neurol, Chattanooga, TN USA

[25] Rush Univ, Med Ctr, Dept Neurosurg, Chicago, IL USA

[26] Klinikum Goethe Univ, Inst Neuroradiol, Frankfurt, Germany

[27] Washington Univ, Dept Neurol, St Louis, MO USA

[28] Univ Missouri, Dept Med, Sch Med, Kansas City, MO USA

来源：

STROKE | 2017年 / 48卷 / 02期

关键词：

quality-adjusted life years; stents; stroke; thrombectomy; tissue-type plasminogen activator; INTRAARTERIAL TREATMENT; RANDOMIZED-TRIAL; MODEL; THERAPY; CARE; TPA;

D O I：

10.1161/STROKEAHA.116.014735

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Background and Purpose Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. Methods In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors. Results Index hospitalization costs were $17183 per patient higher for SST+tPA than for tPA ($45761 versus $28578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11270 versus $16174; P=0.014); total 90-day costs remained higher with SST+tPA ($57031 versus $44752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23203 per patient and was economically dominant when compared with tPA in 90% of bootstrap replicates. Conclusions Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.

引用

页码：379 / 387

页数：9

共 30 条

[1] ACC/AHA Statement on Cost/Value Methodology in Clinical Practice Guidelines and Performance Measures A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and Task Force on Practice Guidelines [J].

Anderson, Jeffrey L. ;

Heidenreich, Paul A. ;

Barnett, Paul G. ;

Creager, Mark A. ;

Fonarow, Gregg C. ;

Gibbons, Raymond J. ;

Halperin, Jonathan L. ;

Hlatky, Mark A. ;

Jacobs, Alice K. ;

Mark, Daniel B. ;

Masoudi, Frederick A. ;

Peterson, Eric D. ;

Shaw, Leslee J. .

CIRCULATION, 2014, 129 (22) :2329-+

[2] A Randomized Trial of Intraarterial Treatment for Acute Ischemic Stroke [J].

Berkhemer, O. A. ;

Fransen, P. S. S. ;

Beumer, D. ;

van den Berg, L. A. ;

Lingsma, H. F. ;

Yoo, A. J. ;

Schonewille, W. J. ;

Vos, J. A. ;

Nederkoorn, P. J. ;

Wermer, M. J. H. ;

van Walderveen, M. A. A. ;

Staals, J. ;

Hofmeijer, J. ;

van Oostayen, J. A. ;

Nijeholt, G. J. Lycklama A. ;

Boiten, J. ;

Brouwer, P. A. ;

Emmer, B. J. ;

de Bruijn, S. F. ;

van Dijk, L. C. ;

Kappelle, L. J. ;

Lo, R. H. ;

Van Dijk, E. J. ;

de Vries, J. ;

de Kort, P. L. M. ;

van Rooij, W. J. J. ;

van den Berg, J. S. P. ;

van Hasselt, B. A. A. M. ;

Aerden, L. A. M. ;

Dallinga, R. J. ;

Visser, M. C. ;

Bot, J. C. J. ;

Vroomen, P. C. ;

Eshghi, O. ;

Schreuder, T. H. C. M. L. ;

Heijboer, R. J. J. ;

Keizer, K. ;

Tielbeek, A. V. ;

den Hertog, H. M. ;

Gerrits, D. G. ;

van den Berg-Vos, R. M. ;

Karas, G. B. ;

Steyerberg, E. W. ;

Flach, H. Z. ;

Marquering, H. A. ;

Sprengers, M. E. S. ;

Jenniskens, S. F. M. ;

Beenen, L. F. M. ;

van den Berg, R. ;

Koudstaal, P. J. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (01) :11-20

[3] Projected costs of ischemic stroke in the United States [J].

Brown, D. L. ;

Boden-Albala, B. ;

Langa, K. M. ;

Lisabeth, L. D. ;

Fair, M. ;

Smith, M. A. ;

Sacco, R. L. ;

Morgenstern, L. B. .

NEUROLOGY, 2006, 67 (08) :1390-1395

[4] Endovascular Therapy for Ischemic Stroke with Perfusion-Imaging Selection [J].

Campbell, B. C. V. ;

Mitchell, P. J. ;

Kleinig, T. J. ;

Dewey, H. M. ;

Churilov, L. ;

Yassi, N. ;

Yan, B. ;

Dowling, R. J. ;

Parsons, M. W. ;

Oxley, T. J. ;

Wu, T. Y. ;

Brooks, M. ;

Simpson, M. A. ;

Miteff, F. ;

Levi, C. R. ;

Krause, M. ;

Harrington, T. J. ;

Faulder, K. C. ;

Steinfort, B. S. ;

Priglinger, M. ;

Ang, T. ;

Scroop, R. ;

Barber, P. A. ;

McGuinness, B. ;

Wijeratne, T. ;

Phan, T. G. ;

Chong, W. ;

Chandra, R. V. ;

Bladin, C. F. ;

Badve, M. ;

Rice, H. ;

de Villiers, L. ;

Ma, H. ;

Desmond, P. M. ;

Donnan, G. A. ;

Davis, S. M. .

NEW ENGLAND JOURNAL OF MEDICINE, 2015, 372 (11) :1009-1018

[5] Stroke treatment economic model (STEM) - Predicting long-term costs from functional status [J].

Caro, JJ ;

Huybrechts, KF .

STROKE, 1999, 30 (12) :2574-2579

[6] Development of a decision-analytic model of stroke care in the United States and Europe [J].

Chambers, MG ;

Koch, P ;

Hutton, J .

VALUE IN HEALTH, 2002, 5 (02) :82-97

[7] IN-HOSPITAL AND ONE-YEAR ECONOMIC OUTCOMES AFTER CORONARY STENTING OR BALLOON ANGIOPLASTY - RESULTS FROM A RANDOMIZED CLINICAL-TRIAL [J].

COHEN, DJ ;

KRUMHOLZ, HM ;

SUKIN, CA ;

HO, KKL ;

SIEGRIST, RB ;

CLEMAN, M ;

HEUSER, RR ;

BRINKER, JA ;

MOSES, JW ;

SAVAGE, MP ;

DETRE, K ;

LEON, MB ;

BAIM, DS .

CIRCULATION, 1995, 92 (09) :2480-2487

[8] Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery [J].

Cramer, Steven C. .

ANNALS OF NEUROLOGY, 2008, 63 (03) :272-287

[9]

Demaerschalk BM, 2010, AM J MANAG CARE, V16, P525

[10] Cost-effectiveness of recombinant activated factor VII in the treatment of intracerebral hemorrhage [J].

Earnshaw, Stephanie R. ;

Joshi, Ashish V. ;

Wilson, Michele R. ;

Rosand, Jonathan .

STROKE, 2006, 37 (11) :2751-2758

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