Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands. (21st January 2021)

• Record Type: Journal Article
• Authors: van Voorst, Henk; Kunz, Wolfgang G; van den Berg, Lucie A; Kappelhof, Manon; Pinckaers, Floor M E; Goyal, Mayank; Hunink, Myriam G M; Emmer, Bart J; Mulder, Maxim J H L; Dippel, Diederik W J; Coutinho, Jonathan M; Marquering, Henk A; Boogaarts, Hieronymus D; van der Lugt, Aad; van Zwam, Wim H; Roos, Yvo B W E M; Buskens, Erik; Dijkgraaf, Marcel G W; Majoie, Charles B L M
• Other Names: author non-byline.; Dippel Diederik W J author non-byline.; Lugt Aad van der author non-byline.; Majoie Charles B L M author non-byline.; Roos Yvo BWEM author non-byline.; Oostenbrugge Robert J van author non-byline.; Zwam Wim H van author non-byline.; Boiten Jelis author non-byline.; Vos Jan Albert author non-byline.; Jansen Ivo G H author non-byline.; Mulder Maxim J H L author non-byline.; Goldhoorn Robert-Jan B author non-byline.; Compagne Kars C J author non-byline.; Kappelhof Manon author non-byline.; Brouwer Josje author non-byline.; Hartog Sanne J den author non-byline.; Hinsenveld Wouter H author non-byline.; Roozenbeek Bob author non-byline.; Es Adriaan C G M van author non-byline.; Emmer Bart J author non-byline.; Coutinho Jonathan M author non-byline.; Schonewille Wouter J author non-byline.; Wermer Marieke J H author non-byline.; Walderveen Marianne A A van author non-byline.; Staals Julie author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M author non-byline.; Dippel Diederik W J author non-byline.; Lugt Aad van der author non-byline.; Majoie Charles B L M author non-byline.; Roos Yvo BWEM author non-byline.; Oostenbrugge Robert J van author non-byline.; Zwam Wim H van author non-byline.; Boiten Jelis author non-byline.; Vos Jan Albert author non-byline.; Jansen Ivo G H author non-byline.; Mulder Maxim J H L author non-byline.; Goldhoorn Robert-Jan B author non-byline.; Compagne Kars C J author non-byline.; Kappelhof Manon author non-byline.; Brouwer Josje author non-byline.; Hartog Sanne J den author non-byline.; Hinsenveld Wouter H author non-byline.; Roozenbeek Bob author non-byline.; Es Adriaan C G M van author non-byline.; Emmer Bart J author non-byline.; Coutinho Jonathan M author non-byline.; Schonewille Wouter J author non-byline.; Wermer Marieke J H author non-byline.; Walderveen Marianne A A van author non-byline.; Staals Julie author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M author non-byline.; Nijeholt Geert Lycklama author non-byline.; Bruijn Sebastiaan F de author non-byline.; Dijk Lukas C van author non-byline.; Bart van der Worp H author non-byline.; Lo Rob H author non-byline.; Dijk Ewoud J van author non-byline.; Boogaarts Hieronymus D author non-byline.; de Vries J author non-byline.; Kort Paul L M de author non-byline.; Tuijl Julia van author non-byline.; Peluso Jo P author non-byline.; Fransen Puck author non-byline.; Dippel Diederik W J author non-byline.; Lugt Aad van der author non-byline.; Majoie Charles B L M author non-byline.; Roos Yvo BWEM author non-byline.; Oostenbrugge Robert J van author non-byline.; Zwam Wim H van author non-byline.; Boiten Jelis author non-byline.; Vos Jan Albert author non-byline.; Jansen Ivo G H author non-byline.; Mulder Maxim J H L author non-byline.; Goldhoorn Robert-Jan B author non-byline.; Compagne Kars C J author non-byline.; Kappelhof Manon author non-byline.; Brouwer Josje author non-byline.; Hartog Sanne J den author non-byline.; Hinsenveld Wouter H author non-byline.; Roozenbeek Bob author non-byline.; Es Adriaan C G M van author non-byline.; Emmer Bart J author non-byline.; Coutinho Jonathan M author non-byline.; Schonewille Wouter J author non-byline.; Wermer Marieke J H author non-byline.; Walderveen Marianne A A van author non-byline.; Staals Julie author non-byline.; Hofmeijer Jeannette author non-byline.; Martens Jasper M author non-byline.; Nijeholt Geert Lycklama author non-byline.; Bruijn Sebastiaan F de author non-byline.; Dijk Lukas C van author non-byline.; Bart van der Worp H author non-byline.; Lo Rob H author non-byline.; Dijk Ewoud J van author non-byline.; Boogaarts Hieronymus D author non-byline.; de Vries J author non-byline.; Kort Paul L M de author non-byline.; Tuijl Julia van author non-byline.; Peluso Jo P author non-byline.; Fransen Puck author non-byline.; Berg Jan van den author non-byline.; Hasselt Boudewijn van author non-byline.; Aerden Leo A M author non-byline.; Dallinga René J author non-byline.; Uyttenboogaart Maarten author non-byline.; Eschgi Omid author non-byline.; Bokkers Reinoud P H author non-byline.; Schreuder Tobien H C M L author non-byline.; Heijboer Roel J J author non-byline.; Keizer Koos author non-byline.; Yo Lonneke S F author non-byline.; Hertog Heleen M den author non-byline.; Sturm Emiel J C author non-byline.; Brouwers Paul J A M author non-byline.; Sprengers Marieke E S author non-byline.; Jenniskens Sjoerd F M author non-byline.; Berg René van den author non-byline.; Yoo Albert J author non-byline.; Beenen Ludo FM author non-byline.; Postma Alida A author non-byline.; Roosendaal Stefan D author non-byline.; Kallen Bas FW van der author non-byline.; Wijngaard Ido R van den author non-byline.; Bot Joost author non-byline.; Doormaal Pieter-Jan van author non-byline.; Meijer Anton author non-byline.; Ghariq Elyas author non-byline.; Proosdij Marc P van author non-byline.; Menno Krietemeijer G author non-byline.; Gerrits Dick author non-byline.; Dinkelaar Wouter author non-byline.; Appelman Auke P A author non-byline.; 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Schupp Lieve M author non-byline.; Collette Sabine author non-byline.; Groot Adrien ED author non-byline.; LeCouffe Natalie E author non-byline.; Konduri Praneeta R author non-byline.; Prasetya Haryadi author non-byline.; Arrarte-Terreros Nerea author non-byline.; Ramos Lucas A author non-byline.;
• Is Part Of: Journal of neurointerventional surgery. Volume 13:Number 12(2021)
• Page Start: 1099
• Page End: 1105
• Publication Date: 2021-01-21
• Subjects: economics -- stroke -- thrombectomy -- intervention -- artery; Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2020-017017
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population. Methods: A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS sub-score were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs. Results: EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: −65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs. Conclusion: One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.