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[Cost-utility analysis: Mechanical thrombectomy plus thrombolysis in ischemic stroke due to large vessel occlusion in the public sector in Chile].
- Source :
-
Medwave [Medwave] 2021 Apr 13; Vol. 21 (3), pp. e8152. Date of Electronic Publication: 2021 Apr 13. - Publication Year :
- 2021
-
Abstract
- Introduction: Several studies demonstrate the therapeutic superiority of thrombolysis plus mechanical thrombectomy versus thrombolysis alone to treat stroke.<br />Objective: To analyze the cost-utility of thrombolysis plus mechanical thrombectomy versus thrombolysis in patients with ischemic stroke due to large vessel occlusion.<br />Methods: Cost-utility analysis. The model used is blended: Decision Tree (first 90 days) and Markov in the long term, of seven health states based on a disease-specific scale, from the Chilean public insurance and societal perspective. Quality-Adjusted Life-Years and costs are evaluated. Deterministic (DSA) and probabilistic (PSA) analyses were carried out.<br />Results: From the public insurance perspective, in the base case, mechanical thrombectomy is associated with lower costs in a lifetime horizon, and with higher benefits (2.63 incremental QALYs, and 1.19 discounted incremental life years), at a Net Monetary Benefit (NMB) of CLP 37,289,874, and an Incremental Cost-Utility Ratio (ICUR) of CLP 3,807,413/QALY. For the scenario that incorporates access to rehabilitation, 2.54 incremental QALYs and 1.13 discounted life years were estimated, resulting in an NMB of CLP 35,670,319 and ICUR of CLP 3,960,624/QALY. In the scenario that incorporates access to long-term care from a societal perspective, the ICUR falls to CLP 951,911/QALY, and the NMB raises to CLP 43,318,072, improving the previous scenarios. In the DSA, health states, starting age, and relative risk of dying were the variables with the greatest influence. The PSA for the base case corroborated the estimates.<br />Conclusions: Thrombolysis plus mechanical thrombectomy adds quality of life at costs acceptable for decision-makers versus thrombolysis alone. The results are consistent with international studies.
- Subjects :
- Brain Ischemia therapy
Cerebrovascular Circulation
Chile
Decision Trees
Health Care Costs
Humans
Ischemic Stroke etiology
Markov Chains
Mechanical Thrombolysis economics
Quality of Life
Stroke therapy
Thrombectomy economics
Thrombolytic Therapy economics
Thrombolytic Therapy methods
Ischemic Stroke therapy
Mechanical Thrombolysis methods
Thrombectomy methods
Subjects
Details
- Language :
- Spanish; Castilian
- ISSN :
- 0717-6384
- Volume :
- 21
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Medwave
- Publication Type :
- Academic Journal
- Accession number :
- 33955971
- Full Text :
- https://doi.org/10.5867/medwave.2021.03.8152