Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration

Johanna M Ospel; Wolfgang G Kunz; Rosalie V McDonough; Wim van Zwam; Floor Pinckaers; Jeffrey L Saver; Michael D Hill; Andrew M Demchuk; Tudor G Jovin; Peter Mitchell; Bruce C V Campbell; Phil White; Keith Muir; Hamza Achit; Serge Bracard; Scott Brown; Mayank Goyal; HERMES Investigators

doi:10.1161/STROKEAHA.121.038407

Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration

Johanna M Ospel, Wolfgang G Kunz, Rosalie V McDonough, Wim van Zwam, Floor Pinckaers, Jeffrey L Saver, Michael D Hill, Andrew M Demchuk, Tudor G Jovin, Peter Mitchell, Bruce C V Campbell, Phil White, Keith Muir, Hamza Achit, Serge Bracard, Scott Brown, Mayank Goyal^*, HERMES Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

BACKGROUND: The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2.

METHODS: Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed.

RESULTS: EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only.

CONCLUSIONS: From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.

Original language	English
Pages (from-to)	226-233
Number of pages	8
Journal	Stroke
Volume	54
Issue number	1
Early online date	6 Dec 2022
DOIs	https://doi.org/10.1161/STROKEAHA.121.038407
Publication status	Published - Jan 2023

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Ospel, J. M., Kunz, W. G., McDonough, R. V., van Zwam, W., Pinckaers, F., Saver, J. L., Hill, M. D., Demchuk, A. M., Jovin, T. G., Mitchell, P., Campbell, B. C. V., White, P., Muir, K., Achit, H., Bracard, S., Brown, S., Goyal, M., & HERMES Investigators (2023). Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration. Stroke, 54(1), 226-233. https://doi.org/10.1161/STROKEAHA.121.038407

@article{ef33eb3f4bab41c49aa4d2f3ae9da26a,

title = "Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration",

abstract = "BACKGROUND: The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2.METHODS: Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed.RESULTS: EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only.CONCLUSIONS: From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.",

author = "Ospel, {Johanna M} and Kunz, {Wolfgang G} and McDonough, {Rosalie V} and {van Zwam}, Wim and Floor Pinckaers and Saver, {Jeffrey L} and Hill, {Michael D} and Demchuk, {Andrew M} and Jovin, {Tudor G} and Peter Mitchell and Campbell, {Bruce C V} and Phil White and Keith Muir and Hamza Achit and Serge Bracard and Scott Brown and Mayank Goyal and {HERMES Investigators}",

note = "Funding Information: The HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) was funded by Medtronic. The company was not involved in the design, analysis, or writing of this study. Publisher Copyright: {\textcopyright} 2023 Lippincott Williams and Wilkins. All rights reserved.",

year = "2023",

month = jan,

doi = "10.1161/STROKEAHA.121.038407",

language = "English",

volume = "54",

pages = "226--233",

journal = "Stroke",

issn = "0039-2499",

publisher = "Wolters Kluwer Health",

number = "1",

}

Ospel, JM, Kunz, WG, McDonough, RV, van Zwam, W , Pinckaers, F, Saver, JL, Hill, MD, Demchuk, AM, Jovin, TG, Mitchell, P, Campbell, BCV, White, P, Muir, K, Achit, H, Bracard, S, Brown, S, Goyal, M & HERMES Investigators 2023, 'Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration', Stroke, vol. 54, no. 1, pp. 226-233. https://doi.org/10.1161/STROKEAHA.121.038407

TY - JOUR

T1 - Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability

T2 - Results From the HERMES Collaboration

AU - Ospel, Johanna M

AU - Kunz, Wolfgang G

AU - McDonough, Rosalie V

AU - van Zwam, Wim

AU - Pinckaers, Floor

AU - Saver, Jeffrey L

AU - Hill, Michael D

AU - Demchuk, Andrew M

AU - Jovin, Tudor G

AU - Mitchell, Peter

AU - Campbell, Bruce C V

AU - White, Phil

AU - Muir, Keith

AU - Achit, Hamza

AU - Bracard, Serge

AU - Brown, Scott

AU - Goyal, Mayank

AU - HERMES Investigators

N1 - Funding Information: The HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) was funded by Medtronic. The company was not involved in the design, analysis, or writing of this study. Publisher Copyright: © 2023 Lippincott Williams and Wilkins. All rights reserved.

PY - 2023/1

Y1 - 2023/1

N2 - BACKGROUND: The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2.METHODS: Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed.RESULTS: EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only.CONCLUSIONS: From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.

AB - BACKGROUND: The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2.METHODS: Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed.RESULTS: EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only.CONCLUSIONS: From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.

U2 - 10.1161/STROKEAHA.121.038407

DO - 10.1161/STROKEAHA.121.038407

M3 - Article

C2 - 36472199

SN - 0039-2499

VL - 54

SP - 226

EP - 233

JO - Stroke

JF - Stroke

IS - 1

ER -

Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration

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