Endovascular treatment for basilar artery occlusion: a cost-effectiveness analysis based on a meta-analysis

作者全名："Wang, Li; Yu, Ying; Zhou, Limei; Xu, Ping; Guo, Xianbin; Xie, Yu; Cai, Junxiu; Pan, Min; Tang, Jie; Gong, Qingtao; Su, Rong; Lou, Yake; Liu, Yan"

作者地址："[Wang, Li; Zhou, Limei; Xu, Ping; Guo, Xianbin; Xie, Yu; Cai, Junxiu; Pan, Min; Tang, Jie; Gong, Qingtao; Su, Rong; Liu, Yan] Zigong Third Peoples Hosp, Dept Neurol, Zigong, Peoples R China; [Yu, Ying] Capital Med Univ, Beijing Tiantan Hosp, Dept Intervent Neuroradiol, Beijing, Peoples R China; [Lou, Yake] Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, Chongqing, Peoples R China"

通信作者："Liu, Y (通讯作者)，Zigong Third Peoples Hosp, Dept Neurol, Zigong, Peoples R China.; Lou, YK (通讯作者)，Chongqing Med Univ, Dept Cardiol, Affiliated Hosp 2, Chongqing, Peoples R China."

来源：FRONTIERS IN NEUROLOGY

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:001092290400001

JCR分区：Q2

影响因子：2.7

年份：2023

卷号：14

期号：　

开始页：　

结束页：　

文献类型：Article

关键词：cost effectiveness analysis; endovascular treatment; basilar artery occlusion; stroke; meta-analysis

摘要："ObjectiveThis study aimed to investigate the efficacy and economic effect of endovascular treatment (EVT) combined with standard medical treatment (SMT) vs. SMT alone in Chinese patients with basilar artery occlusion (BAO) from the perspective of the Chinese healthcare system.MethodsWe conducted a cost-effectiveness analysis using the results from a meta-analysis comparing EVT and SMT efficacy in Chinese patients with BAO-induced stroke using direct medical costs from the China National Stroke Registry. The meta-analysis's primary outcome was excellent functional outcome (mRS scores of 0-2), with secondary outcomes being poor functional outcome (mRS scores of 3-5) and death (mRS score of 6). To compare EVT plus SMT's cost-effectiveness with that of SMT alone, we constructed a combined decision tree and Markov model with a lifetime duration and a 3-month cycle length. The primary cost-effectiveness outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost per incremental quality-adjusted life year (QALY). EVT was considered cost-effective if the ICER was lower than the willingness-to-pay (WTP) threshold of three times the per capita gross domestic product (GDP) in 2021 in China; otherwise, it would not be cost-effective.ResultsThe meta-analysis results indicated that EVT could increase the incidence of excellent functional outcomes, with a risk ratio (RR) of 2.23 (95% confidence interval, CI, 1.18-4.21), p = 0.01. Simultaneously, EVT reduced the risk of poor functional outcome and mortality in the EVT group, with RRs of 0.83 (95% CI, 0.67-1.03), p = 0.09, and 0.71 (95% CI, 0.59-0.85), p = 0.0002, respectively. The study also found that EVT plus SMT resulted in a lifetime effectiveness of 2.15 QALY (3.88 life years) for 32,213 international dollars (Intl.$) per patient with BAO. In contrast, SMT alone achieved an effectiveness of 1.46 QALY (3.03 life years) with a total cost of Intl.$ 13,592 per patient. The ICER was Intl.$ 27,265 per QALY (Intl.$ 22,098 per life-year), which fell below the WTP threshold.ConclusionCompared to SMT, EVT improves the prognosis of BAO-induced stroke. Considering the Chinese healthcare system, adding EVT to SMT proves to be cost-effective for patients with BAO compared to SMT alone."

基金机构："The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article."

基金资助正文："The author(s) declare that no financial support was received for the research, authorship, and/or publication of this article."