The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory
© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the expected infarction is large (defined as an Alberta Stroke Program Early CT Score of <6).
OBJECTIVE: To perform a meta-analysis of recent trials comparing MT with best medical management (BMM) for treatment of acute ischemic stroke with large infarction territory, and then to determine the cost-effectiveness associated with those treatments.
METHODS: A meta-analysis of the RESCUE-Japan, SELECT2, and ANGEL-ASPECT trials was conducted using R Studio. Statistical analysis employed the weighted average normal method for calculating mean differences from medians in continuous variables and the risk ratio for categorical variables. TreeAge software was used to construct a cost-effectiveness analysis model comparing MT with BMM in the treatment of ischemic stroke with large infarction territory.
RESULTS: The meta-analysis showed significantly better functional outcomes, with higher rates of patients achieving a modified Rankin Scale score of 0-3 at 90 days with MT as compared with BMM. In the base-case analysis using a lifetime horizon, MT led to a greater gain in quality-adjusted life-years (QALYs) of 3.46 at a lower cost of US$339 202 in comparison with BMM, which led to the gain of 2.41 QALYs at a cost of US$361 896. The incremental cost-effectiveness ratio was US$-21 660, indicating that MT was the dominant treatment at a willingness-to-pay of US$70 000.
CONCLUSIONS: This study shows that, besides having a better functional outcome at 90-days' follow-up, MT was more cost-effective than BMM, when accounting for healthcare cost associated with treatment outcome.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
Journal of neurointerventional surgery - (2024) vom: 12. März |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Aslan, Assala [VerfasserIn] |
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Date Revised 12.03.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1136/jnis-2023-021368 |
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| 245 | 1 | 4 | |a The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory |
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| 520 | |a © Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the expected infarction is large (defined as an Alberta Stroke Program Early CT Score of <6) | ||
| 520 | |a OBJECTIVE: To perform a meta-analysis of recent trials comparing MT with best medical management (BMM) for treatment of acute ischemic stroke with large infarction territory, and then to determine the cost-effectiveness associated with those treatments | ||
| 520 | |a METHODS: A meta-analysis of the RESCUE-Japan, SELECT2, and ANGEL-ASPECT trials was conducted using R Studio. Statistical analysis employed the weighted average normal method for calculating mean differences from medians in continuous variables and the risk ratio for categorical variables. TreeAge software was used to construct a cost-effectiveness analysis model comparing MT with BMM in the treatment of ischemic stroke with large infarction territory | ||
| 520 | |a RESULTS: The meta-analysis showed significantly better functional outcomes, with higher rates of patients achieving a modified Rankin Scale score of 0-3 at 90 days with MT as compared with BMM. In the base-case analysis using a lifetime horizon, MT led to a greater gain in quality-adjusted life-years (QALYs) of 3.46 at a lower cost of US$339 202 in comparison with BMM, which led to the gain of 2.41 QALYs at a cost of US$361 896. The incremental cost-effectiveness ratio was US$-21 660, indicating that MT was the dominant treatment at a willingness-to-pay of US$70 000 | ||
| 520 | |a CONCLUSIONS: This study shows that, besides having a better functional outcome at 90-days' follow-up, MT was more cost-effective than BMM, when accounting for healthcare cost associated with treatment outcome | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Stroke | |
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| 700 | 1 | |a Adeeb, Nimer |e verfasserin |4 aut | |
| 700 | 1 | |a Musmar, Basel |e verfasserin |4 aut | |
| 700 | 1 | |a Salim, Hamza A |e verfasserin |4 aut | |
| 700 | 1 | |a Kandregula, Sandeep |e verfasserin |4 aut | |
| 700 | 1 | |a Dmytriw, Adam A |e verfasserin |4 aut | |
| 700 | 1 | |a Griessenauer, Christoph J |e verfasserin |4 aut | |
| 700 | 1 | |a De Alba, Luis |e verfasserin |4 aut | |
| 700 | 1 | |a Arevalo, Octavio |e verfasserin |4 aut | |
| 700 | 1 | |a Burkhardt, Jan Karl |e verfasserin |4 aut | |
| 700 | 1 | |a Pereira, Vitor M |e verfasserin |4 aut | |
| 700 | 1 | |a Jabbour, Pascal |e verfasserin |4 aut | |
| 700 | 1 | |a Guthikonda, Bharat |e verfasserin |4 aut | |
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