12 Potential cost-effectiveness of spectral photon-counting computed tomography (SPCCT) versus CT combined with CT angiography (CTA) in the identification and treatment of ischaemic stroke patients in the UK. (December 2018)

• Record Type: Journal Article
• Authors: Claire Peultier, Anne; Redekop, Ken; Severens, Hans
• Is Part Of: Postgraduate medical journal. Volume 94(2018)Supplement 1
• Page Start: A10
• Page End: A11
• Publication Date: 2018-12
• Subjects: Medicine -- Periodicals; 610
• DOI: 10.1136/postgradmedj-2018-fpm.23
• Languages: English
• ISSNs: 0032-5473

Abstract

Abstract : Introduction: In current care, eligibility for thrombolysis or mechanical thrombectomy as acute stroke treatments is based on imaging (CT and CTA), time since onset and patient history. Thrombectomy will be routinely commissioned by NHS England provided it can be achieved within 6 hours of the onset of stroke. In case advanced imaging indicates salvageable brain tissue beyond the 6 hour window, thrombectomy will be commissioned up to 12 hours after stroke onset. SPCCT is an emerging technology expected to have an increased resolution. Besides identifying ischaemic stroke patients, SPCCT is expected to provide information about the presence of salvageable brain tissue and, in turn, identify those who are likely to benefit from thrombectomy beyond 6 hours. The aim of this study was to investigate the potential cost-effectiveness of SPCCT (versus CT +CTA) in identifying and treating ischaemic stroke patients in the UK. Methods: A decision-analytic model built on a decision tree and a Markov trace was developed. A hypothetical cohort of suspected stroke patients aged 74 was modeled (first stroke ever). Costs, outcomes and probabilities were obtained from the literature. Outcomes of the model included costs, life-years, quality-adjusted life-years, and incremental cost-effectiveness ratios. Univariate and probabilistic sensitivity analyses were performed. Results: Three scenarios were simulated in which the proportion of patients referred to thrombectomy after 6 hours was varied from 5%, to 10% and to 15% with SPCCT while it remained constant to 0% with CT-CTA. Three levels of SPCCT accuracy were simulated (perfect positive predictive value (PPV) (100%), intermediate PPV (78.1%), and low PPV (46.9%)). Over the three-month and lifetime horizons, all SPCCT-based scenarios improved QALYs and LYs compared to CT-CTA. Based on the currently used estimates, the probability that SPCCT is cost-effective at a willingness-to-pay threshold of £10 000 per QALY is above 50% in all scenarios. Conclusions: Based on preliminary results, replacing CT-CTA with SPCCT to identify and treat ischaemic stroke patients beyond 6 hours may be good value for money. However, additional data regarding clinical outcomes following SPCCT based strategies are needed before the cost-effectiveness can be fully assessed.