TY - JOUR
T1 - Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy
T2 - A United States and European perspective
AU - Zaidat, Osama O.
AU - Ribo, Marc
AU - Mattle, Heinrich Paul
AU - Saver, Jeffrey L.
AU - Bozorgchami, Hormozd
AU - Yoo, Albert J.
AU - Ehm, Alexandra
AU - Kottenmeier, Emilie
AU - Cameron, Heather L.
AU - Qadeer, Rana A.
AU - Andersson, Tommy
N1 - Publisher Copyright:
© 2021 Georg Thieme Verlag. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - Background First-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed. Objective To assess the economic impact of achieving complete or near complete reperfusion after the first pass. Methods Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c-3 was achieved, stratified into two groups: (1) mTICI 2c-3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK). Results Among patients who achieved mTICI 2c-3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0-2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24-33% reduction) and annual care (11-27% reduction) costs across all countries. Conclusions FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.
AB - Background First-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed. Objective To assess the economic impact of achieving complete or near complete reperfusion after the first pass. Methods Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c-3 was achieved, stratified into two groups: (1) mTICI 2c-3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK). Results Among patients who achieved mTICI 2c-3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0-2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24-33% reduction) and annual care (11-27% reduction) costs across all countries. Conclusions FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.
KW - economics
KW - stroke
KW - thrombectomy
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U2 - 10.1136/neurintsurg-2020-016930
DO - 10.1136/neurintsurg-2020-016930
M3 - Article
C2 - 33443119
AN - SCOPUS:85098177326
SN - 1759-8478
VL - 13
SP - 1117
EP - 1123
JO - Journal of neurointerventional surgery
JF - Journal of neurointerventional surgery
IS - 12
ER -