Evidence map›Paper›PMID 36258310›Full record

ArticleBMJ open2022

Economic impact of the first pass effect in mechanical thrombectomy for acute ischaemic stroke treatment in Spain: a cost-effectiveness analysis from the national health system perspective.

Eva González Diaz, Carlos Rodríguez-Paz, Andres Fernandez-Prieto, Mario Martínez-Galdámez, Rosa Martínez-Moreno, Joaquín Ortega Quintanilla, Alejandro Tomasello, Joaquín Zamarro, David Liebeskind, Osama O Zaidat and 1 more

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In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Eva González DiazNeurointerventional Radiology, Radiology Department, Cruces University Hospital, Barakaldo, Spain evagonzalezdiaz@yahoo.com.ORCID 0000-0002-2749-7155
Carlos Rodríguez-PazNeuroradiology Unit, Department of Radiology, Hospital Álvaro Cunqueiro, Vigo, Spain.
Andres Fernandez-PrietoNeurointerventional Radiology, Radiology Department, Hospital Universitario La Paz, Madrid, Spain.
Mario Martínez-GaldámezNeuroradiology Unit, University Clinical Hospital of Valladolid, Valladolid, Spain.
Rosa Martínez-MorenoHospital Universitario Virgen de las Nieves, Granada, Spain.
Joaquín Ortega QuintanillaInterventional Neuroradiology, Hospital Universitario Virgen del Rocío, Sevilla, Andalucía, Spain.
Alejandro TomaselloInterventional Neuroradiology Section, Department of Radiology, Vall d'Hebron University Hospital, Barcelona, Spain.
Joaquín ZamarroInterventional Neuroradiology, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
David LiebeskindNeurovascular Imaging Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, California, USA.
Osama O ZaidatSt Vincent Mercy Hospital, Toledo, Ohio, USA.
Nils H Mueller-KronastAdvanced Neuroscience Network/Tenet South Florida, Delray Beach, Florida, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveThe mechanical thrombectomy (MT) benefit is related to the degree of reperfusion achieved. First pass effect (FPE) is defined as complete/near revascularisation of the large-vessel occlusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) after a single device pass. This study assessed the health benefit and economic impact of achieving FPE for acute ischaemic stroke (AIS) patients from the Spanish National Health System (NHS) perspective.

designA lifetime Markov model was used to estimate incremental costs and health outcomes (measured in quality-adjusted life-years (QALYs)) of patients that achieve FPE. A subanalysis of the Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischaemic Stroke (STRATIS) registry was performed to obtain clinical outcomes. The base case included all patients that achieved at least a final mTICI ≥2 b, while the alternative scenario included all patients regardless of their final mTICI (0-3). Treatment costs were updated to reflect current practice based on expert panel consensus, while other acute and long-term costs were obtained from a previous cost-effectiveness analysis of MT performed in Spain. Sensitivity analyses were performed to assess the model's robustness.

settingSpanish healthcare perspective.

participantsAIS patients in Spain.

interventionsFPE following MT. OUTCOME MEASURES: The model estimated QALYs, lifetime costs and net monetary benefit for the FPE and non-FPE group, depending on the inclusion of reperfusion groups and formal care costs.

resultsSTRATIS subanalysis estimated significantly better clinical outcomes at 90 days for the FPE group in all scenarios. In the base case, the model estimated lifetime cost saving per patient of €16 583 and an incremental QALY gain of 1.2 years of perfect health for the FPE group. Cost savings and QALY gains were greater in the alternative scenario (-€44 289; 1.75). In all scenarios, cost savings were driven by the long-term cost reduction.

conclusionAchieving FPE after MT can lead to better health outcomes per AIS patient and important cost savings for the Spanish NHS.

Indexed as

Brain IschemiaIschemic StrokeStrokeCost-Benefit AnalysisHumansSpainThrombectomyTreatment OutcomeHEALTH ECONOMICSInterventional radiologyNeuroradiologyStroke

Identifiers

PMID36258310
PMCPMC9438077

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.