In what fucking universe do you live that cost is more important than results? And you aren't even including the cost of a dead neuron.
What stroke survivor fucking cares about cost effectiveness? They only care about results, which aren't even mentioned here.
I suggest having your stroke hospital pay $1000 a dead neuron, at 1.9 million dead neurons a minute that is only $114 million an hour. That would get stroke solved fast.
Cost-effectiveness of Mechanical Thrombectomy More Than 6 Hours After Symptom Onset Among Patients With Acute Ischemic Stroke
Question Is mechanical thrombectomy in the extended treatment window cost-effective across patient subgroups in the United States?
Findings This economic evaluation study found that mechanical thrombectomy provides good value for money in all the defined subgroups the 2 randomized clinical trials evaluated. Sensitivity analyses revealed a wide range of probabilities for late mechanical thrombectomy to be cost-effective at the willingness-to-pay threshold of $50 000 per quality-adjusted life-year.
Meaning The results of this study suggest that attention should be placed on increasing access to mechanical thrombectomy rather than on developing subgroup-specific guidelines unless workforce and budget constraints require prioritization.
Abstract
Importance Two 2018 randomized controlled trials (DAWN and DEFUSE 3) demonstrated the clinical benefit of mechanical thrombectomy (MT) more than 6 hours after onset in acute ischemic stroke (AIS). Health-economic evidence is needed to determine whether the short-term health benefits of late MT translate to a cost-effective option during a lifetime in the United States.
Objective To compare the cost-effectiveness of 2 strategies (MT added to standard medical care [SMC] vs SMC alone) for various subgroups of patients with AIS receiving care more than 6 hours after symptom onset.
Design, Setting, and Participants This economic evaluation study used the results of the DAWN and DEFUSE 3 trials to populate a cost-effectiveness model from a US health care perspective combining a decision tree and Markov trace. The DAWN and DEFUSE 3 trials enrolled 206 international patients from 2014 to 2017 and 182 US patients from 2016 to 2017, respectively. Patients were followed until 3 months after stroke. The clinical outcome at 3 months was available for 29 subgroups of patients with AIS and anterior circulation large vessel occlusions. Data analysis was conducted from July 2018 to October 2019.
Exposures MT with SMC in the extended treatment window vs SMC alone.
Main Outcomes and Measures Expected costs and quality-adjusted life-years (QALYs) during lifetime were estimated. Deterministic results (incremental costs and effectiveness, incremental cost-effectiveness ratios, and net monetary benefit) were presented, and probabilistic analyses were performed for the total populations and 27 patient subgroups.
Results In the DAWN study, the MT group had a mean (SD) age of 69.4 (14.1) years and 42 of 107 (39.3%) were men, and the control group had a mean (SD) age of 70.7 (13.2) years and 51 of 99 (51.5%) were men. In the DEFUSE 3 study, the MT group had a median (interquartile range) age of 70 (59-79) years, and 46 of 92 (50.0%) were men, and the control group had a median (interquartile range) age of 71 (59-80) years, and 44 of 90 (48.9%) were men. For the total trial population, incremental cost-effectiveness ratios were $662/QALY and $13 877/QALY based on the DAWN and DEFUSE 3 trials, respectively. MT with SMC beyond 6 hours had a probability greater than 99.9% of being cost-effective vs SMC alone at a willingness-to-pay threshold of $100 000/QALY. Subgroup analyses showed a wide range of probabilities for MT with SMC to be cost-effective at a willingness-to-pay threshold of $50 000/QALY, with the greatest uncertainty observed for patients with a National Institute of Health Stroke Scale score of at least 16 and for those aged 80 years or older.
Conclusions and Relevance The results of this study suggest that late MT added to SMC is cost-effective in all subgroups evaluated in the DAWN and DEFUSE 3 trials, with most results being robust in probabilistic sensitivity analyses. Future MT evidence-gathering could focus on older patients and those with National Institute of Health Stroke Scale scores of 16 and greater.
The randomized clinical trials DAWN and DEFUSE 3 demonstrated superior functional outcomes of mechanical thrombectomy (MT) at 90 days among patients with acute ischemic stroke (AIS) treated 6 to 24 hours after they were last known well (eAppendix in the Supplement).1,2 Health-economic evidence is needed to determine whether the short-term functional benefit of late MT translates to cost-effectiveness in the United States over a lifetime. A prolonged MT window implies advanced neuroimaging selection of patients and greater neurology and endovascular staff, which are costly and potentially critical resources. Furthermore, factors such as time from symptom onset, patient characteristics, National Institutes of Health Stroke Scale (NIHSS) score, mode of presentation, imaging criteria, and localization of the occlusion might influence the long-term value of late MT. Analyzing the magnitude of the long-term cost-effectiveness of late window MT per patient subgroup could expand the evidence and help inform allocation of critical resources. The aim of this study was to compare the cost-effectiveness of MT with standard medical care (SMC) vs SMC alone by patient subgroup in the late window in the United States.
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