Evidence map›Paper›PMID 37905959›Full record

ArticleEuropean stroke journal2024

Cost-effectiveness of endovascular treatment versus best medical management in basilar artery occlusion stroke: A U.S. healthcare perspective.

Dirk Mehrens, Matthias P Fabritius, Paul Reidler, Thomas Liebig, Saif Afat, Johanna M Ospel, Matthias F Fröhlich, Julian Schwarting, Jens Ricke, Konstantinos Dimitriadis and 2 more

Abstract read
In one paragraph

Article in European stroke journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed, 1 pooled it
–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

1 citing paper in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
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

12 authors.

Dirk MehrensDepartment of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.ORCID 0000-0001-5114-8935
Matthias P FabritiusDepartment of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.ORCID 0000-0002-3471-4701
Paul ReidlerDepartment of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
Thomas LiebigInstitute of Neuroradiology, LMU University Hospital, LMU Munich, Munich, Germany.
Saif AfatDepartment of Radiology, University of Tübingen, Tübingen, Germany.
Johanna M OspelDepartments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.ORCID 0000-0003-0029-6764
Matthias F FröhlichDepartment of Radiology and Nuclear Medicine, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany.
Julian SchwartingDepartment of Diagnostic and Interventional Neuroradiology, Technical University Munich, Munich, Germany.ORCID 0000-0003-0616-5706
Jens RickeDepartment of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.
Konstantinos DimitriadisInstitute for Stroke and Dementia Research, LMU University Hospital, LMU Munich, Munich, Germany.
Mayank GoyalDepartments of Radiology and Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.
Wolfgang G KunzDepartment of Radiology, LMU University Hospital, LMU Munich, Munich, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionTwo recent studies showed clinical benefit for endovascular treatment (EVT) in basilar artery occlusion (BAO) stroke up to 12 h (ATTENTION) and between 6 and 24 h from onset (BAOCHE). Our aim was to investigate the cost-effectiveness of EVT from a U.S. healthcare perspective. MATERIALS AND

methodsClinical input data were available for both trials, which were analyzed separately. A decision model was built 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 healthcare and a societal perspective. Incremental cost-effectiveness ratios (ICER) were calculated, deterministic (DSA) and probabilistic (PSA) sensitivity analyses were performed.

resultsEVT in addition to best medical management (BMM) resulted in additional lifetime costs of $32,063 in the ATTENTION trial and lifetime cost savings of $7690 in the BAOCHE trial (societal perspective). From a healthcare perspective, EVT led to incremental costs and effectiveness of $37,389 and 2.0 QALYs (ATTENTION) as well as $3516 and 1.9 QALYs (BAOCHE), compared to BMM alone. The ICER values were $-4052/QALY (BAOCHE) and $15,867/QALY (ATTENTION) from a societal perspective. In each trial, PSA showed EVT to be cost-effective in most calculations (99.9%) for a willingness-to-pay threshold of $100,000/QALY. Cost of EVT and age at stroke represented the greatest impact on the ICER. DISCUSSION: From an economic standpoint with a lifetime horizon, EVT in addition to BMM is estimated to be highly effective and cost-effective in BAO stroke.

Indexed as

Basilar ArteryStrokeClinical Trials as TopicCost-Benefit AnalysisDelivery of Health CareHumansbasilar artery occlusioncost-effectivenessischemic strokeThrombectomy

Identifiers

PMID37905959
PMCPMC10916810

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.