Evidence map›Paper›PMID 38153049›Full record

ArticleEuropean stroke journal2024

Cost-effectiveness of endovascular treatment after 6-24 h in ischaemic stroke patients with collateral flow on CT-angiography: A model-based economic evaluation of the MR CLEAN-LATE trial.

Florentina Me Pinckaers, Silvia Maa Evers, Susanne Gh Olthuis, Hieronymus D Boogaarts, Alida A Postma, Robert J van Oostenbrugge, Wim H van Zwam, Janneke Pc Grutters

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 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing 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

2 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Article
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

8 authors.

Florentina Me PinckaersDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.ORCID 0000-0002-8336-6897
Silvia Maa EversCare and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
Susanne Gh OlthuisSchool for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.ORCID 0000-0002-2802-1511
Hieronymus D BoogaartsDepartment of Neurosurgery, Radboudumc, Nijmegen, The Netherlands.
Alida A PostmaDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Robert J van OostenbruggeSchool for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands.
Wim H van ZwamDepartment of Radiology and Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.ORCID 0000-0003-1631-7056
Janneke Pc GruttersDepartment for Health Evidence, Radboudumc, Nijmegen, The Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe MR CLEAN-LATE trial has shown that patient selection for endovascular treatment (EVT) in the late window (6-24 h after onset or last-seen-well) based on the presence of collateral flow on CT-angiography is safe and effective. We aimed to assess the cost-effectiveness of late-window collateral-based EVT-selection compared to best medical management (BMM) over a lifetime horizon (until 95 years of age). MATERIALS AND

methodsA model-based economic evaluation was performed from a societal perspective in The Netherlands. A decision tree was combined with a state-transition (Markov) model. Health states were defined by the modified Rankin Scale (mRS). Initial probabilities at 3-months post-stroke were based on MR CLEAN-LATE data. Transition probabilities were derived from previous literature. Information on short- and long-term resource use and utilities was obtained from a study using MR CLEAN-LATE and cross-sectional data. All costs are expressed in 2022 euros. Costs and quality-adjusted life years (QALYs) were discounted at a rate of 4% and 1.5%, respectively. The effect of parameter uncertainty was assessed using probabilistic sensitivity analysis (PSA).

resultsOn average, the EVT strategy cost €159,592 (95% CI: €140,830-€180,154) and generated 3.46 QALYs (95% CI: 3.04-3.90) per patient, whereas the costs and QALYs associated with BMM were €149,935 (95% CI: €130,841-€171,776) and 2.88 (95% CI: 2.48-3.29), respectively. The incremental cost-effectiveness ratio per QALY and the incremental net monetary benefit were €16,442 and €19,710, respectively. At a cost-effectiveness threshold of €50,000/QALY, EVT was cost-effective in 87% of replications. DISCUSSION AND

conclusionCollateral-based selection for late-window EVT is likely cost-effective from a societal perspective in The Netherlands.

Indexed as

Computed Tomography AngiographyCost-Benefit AnalysisEndovascular ProceduresIschemic StrokeQuality-Adjusted Life YearsAgedAged, 80 and overCollateral CirculationFemaleHumansMaleMiddle AgedModels, EconomicNetherlandscollateral circulationcost-effectiveness analysisIschaemic strokelate windowthrombectomy

Identifiers

PMID38153049
PMCPMC11318439

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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.