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Research ArticleNeurointervention

Is Mechanical Clot Removal or Disruption a Cost-Effective Treatment for Acute Stroke?

M.N. Nguyen-Huynh and S.C. Johnston
American Journal of Neuroradiology February 2011, 32 (2) 244-249; DOI: https://doi.org/10.3174/ajnr.A2329
M.N. Nguyen-Huynh
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S.C. Johnston
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    Fig 1.

    Decision tree used to compare cost-effectiveness of aggressive NIR treatment with the best medical therapy for a patient presenting with acute ischemic stroke within 8 hours of symptom onset but beyond the 3-hour window for IV tPA.

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    Fig 2.

    Univariate sensitivity analyses of recanalization rates over an appropriate range of uncertainty for those undergoing NIR treatment (A) and best medical therapy (B). Arrows indicate base-case values for NIR treatment (84%) and best medical therapy (24%). Rates that lead to a net of <$50,000/QALY gained are usually considered cost-effective (bold dashed line).

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    Fig 3.

    Univariate sensitivity analyses of symptomatic ICH rates with NIR treatment (A) and best medical therapy (B). Arrows indicate base-case values (6.3% for NIR and 2% for best medical therapy). Rates that lead to a net of <$50,000/QALY gained are usually considered cost-effective.

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    Fig 4.

    Monte Carlo simulation of all input variables (except age and discount rate). The oval represents the 95% CI of the distribution of cost-effectiveness of the intervention, all of which is <$50,000/QALY as represented by the diagonal dashed line.

Tables

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  • Model inputs analysis for base case and range of univariate sensitivity

    Model InputAggressive NIR Rx (range)Best Medical Therapy (range)Reference
    Recanalization rate84% (63%–100%)24% (14%–50%)Rha and Saver, 20079
    Symptomatic ICH
        With recanalization6.2% (4%–14%)2.0%Smith et al, 200812; Furlan et al, 199915
        Without recanalization17.3%5.5%Smith et al, 200812; Furlan et al, 199915
    Relative utility
        Permanent mild disability (mRS 0–2)0.850.85Earnshaw et al, 200619
        Permanent moderate-severe disability (mRS 3–5)0.270.27Earnshaw et al, 200619
        Death00
    Costs
        With ICH complication$28,087$10,245Medicare MS-DRG 023 and 06416
        Without ICH complication$19,210    $4,686Medicare MS-DRG 024 and 06616
        Mild disability (annual)$2,200$2,200Gage et al, 199529
        Moderate-severe disability (annual)$20,000$20,000Gage et al, 199529
        Discount rate3.00%3.00%Gold et al, 199613
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American Journal of Neuroradiology: 32 (2)
American Journal of Neuroradiology
Vol. 32, Issue 2
1 Feb 2011
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M.N. Nguyen-Huynh, S.C. Johnston
Is Mechanical Clot Removal or Disruption a Cost-Effective Treatment for Acute Stroke?
American Journal of Neuroradiology Feb 2011, 32 (2) 244-249; DOI: 10.3174/ajnr.A2329

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Is Mechanical Clot Removal or Disruption a Cost-Effective Treatment for Acute Stroke?
M.N. Nguyen-Huynh, S.C. Johnston
American Journal of Neuroradiology Feb 2011, 32 (2) 244-249; DOI: 10.3174/ajnr.A2329
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