O-002 Lifetime benefit and cost consequences of the achieved grade of reperfusion after thrombectomy for stroke based on hermes collaboration data. (22nd July 2018)

• Record Type: Journal Article
• Authors: Kunz, W; Almekhlafi, M; Menon, B; Saver, J; Dippel, D; Majoie, C; Liebeskind, D; Jovin, T; Davalos, A; Bracard, S; Guillemin, F; Campbell, B; Mitchell, P; White, P; Muir, K; Brown, S; Demchuk, A; Hill, M; Goyal, M
• Is Part Of: Journal of neurointerventional surgery. Volume 10(2018)Supplement 2
• Page Start: A2
• Page End: A3
• Publication Date: 2018-07-22
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2018-SNIS.2
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Purpose: The benefit that endovascular thrombectomy (EVT) offers to stroke patients with large vessel occlusions depends strongly on reperfusion grade as defined by the eTICI (extended Thrombolysis in Cerebral Infarction) scale. Our aim was to determine the lifetime quality of life and cost consequences of reperfusion for patients, healthcare systems, and society. Materials and methods: A Markov model estimated lifetime quality-adjusted life years (QALY) of EVT-treated patients and associated costs based on eTICI grades. The analysis was performed from a United States perspective with two cost frameworks: 1) healthcare costs and 2) societal costs, which include productivity losses and costs of informal care given by family members. Input parameters were based on best available evidence, including patient data from the 7-trial HERMES collaboration (ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, SWIFT PRIME, PISTE, THRACE). The lead analysis was conducted for stroke onset at 65 years. Probabilistic sensitivity analysis was performed using Monte Carlo simulations. Results: Lifetime QALYs increased for every grade of improved reperfusion (figure 1A). On average, eTICI 3 resulted in 6.50 QALYs over the patients' lifetimes, eTICI 2 c (90%–99%) in 5.89 QALYs, eTICI 2b (67%–89%) in 5.79 QALYs, eTICI 2b (50%–66%) in 4.80 QALYs, eTICI 2a in 3.55 QALYs, and eTICI 1 or 0 in 2.57 QALYs. In contrast, the healthcare and societal costs of each QALY yielded by EVT decreased for every grade of improved reperfusion (Figure 1B). The advantage of achieving eTICI 3 over eTICI 2b (50%–66%) reperfusion results in average cost-savings of about $15, 000/QALY per patient incurred by the healthcare system and $20, 000/QALY per patient incurred by the society. Conclusion: Every grade of improved reperfusion grants stroke patients additional QALYs and substantially reduces healthcare and societal costs per QALY. The clinical benefit and cost-savings of eTICI 3 reperfusion support to assess procedural strategies aiming at complete reperfusion for safety and feasibility, even when initial reperfusion seems to be adequate (eTICI 2b). Disclosures: W. Kunz: 1; C; The HERMES collaboration was supported by Medtronic through an unrestricted research grant to the University of Calgary. M. Almekhlafi: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. B. Menon: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. J. Saver: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. D. Dippel: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. C. Majoie: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. D. Liebeskind: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. T. Jovin: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. A. Davalos: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. S. Bracard: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. F. Guillemin: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. B. Campbell: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. P. Mitchell: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. P. White: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. K. Muir: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. S. Brown: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. A. Demchuk: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. M. Hill: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary. M. Goyal: 1; C; The HERMES pooled analysis project is supported by an unrestricted grant from Medtronic to the University of Calgary.