Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study

Author(s):
Voorst, H. van; Hoving, J.W.; Koopman, M.S.; Daems, J.D.; Peerlings, D.; Buskens, E.; Lingsma, H.F.; Beenen, L.F.M.; Jong, H.W.A.M. de; Berkhemer, O.A.; Zwam, W.H. van; Roos, Y.B.W.E.M.; Walderveen, M.A.A. van; Wijngaard, I. van den; Dippel, D.W.J.; Yoo, A.J.; Campbell, B.C.V.; Kunz, W.G.; Emmer, B.J.; Majoie, C.B.L.M.; CLEOPATRA Investigators; CONTRAST Consortium; MR CLEAN Registry Investigators
Published
2024
Publication type
Article / Letter to editor

Abstract

Objectives

CT perfusion (CTP) has been suggested to increase the rate of large vessel occlusion (LVO) detection in patients suspected of acute ischemic stroke (AIS) if used in addition to a standard diagnostic imaging regime of CT angiography (CTA) and non-contrast CT (NCCT). The aim of this study was to estimate the costs and health effects of additional CTP for endovascular treatment (EVT)–eligible occlusion detection using model-based analyses.

Methods In this Dutch, nationwide retrospective cohort study with model-based health economic evaluation, data from 701 EVT-treated patients with available CTP results were included (January 2018–March 2022; trialregister.nl:NL7974). We compared a cohort undergoing NCCT, CTA, and CTP (NCCT + CTA + CTP) with a generated counterfactual where NCCT and CTA (NCCT + CTA) was used for LVO detection. The NCCT + CTA strategy was simulated using diagnostic accuracy values and EVT effects from the literature. A Markov model was used to simulate 10-year follow-up. We adopted a healthcare payer perspective for costs in euros and health gains in quality-adjusted life years (QALYs). The primary outcome was the net monetary benefit (NMB) at a willingness to pay of €80,000; secondary outcomes were the difference between LVO detection strategies in QALYs (ΔQALY) and costs (ΔCosts) per LVO patient. Results We included 701 patients (median age: 72, IQR: [62–81]) years). Per LVO patient, CTP-based occlusion detection resulted in cost savings (ΔCosts median: € − 2671, IQR: [€ − 4721; € − 731]), a health gain (ΔQALY median: 0.073, IQR: [0.044; 0.104]), and a positive NMB (median: €8436, IQR: [5565; 11,876]) per LVO patient. Conclusion CTP-based screening of suspected stroke patients for an endovascular treatment eligible large vessel occlusion was cost-effective.

Ischemic strokeFour-dimensional computed tomographyDiagnosisThrombectomyHealth Care Economics and Organizations
Date issued
2024-04-30
Language
English
Is part of
European Radiology (2024), Vol. 34, no. 4, p. 2152-2167
hdl
1887/4246855
doi
10.1007/s00330-023-10119-y
URL
https://link.springer.com/article/10.1007/s00330-023-10119-y