Costs and health effects of CT perfusion-based selection for endovascular thrombectomy within 6 hours of stroke onset: a model-based health economic evaluatin.
Henk van VoorstJan W HovingMiou S KoopmanJasper D DaemsDaan PeerlingsErik BuskensHester LingsmaHenk A MarqueringHugo W A M de JongOlvert A BerkhemerWim H van ZwamMarianne A A van WalderveenIdo R van den WijngaardDiederik W J DippelAlbert J YooBruce CampbellWolfgang G KunzCharles B MajoieBart J Emmernull nullnull nullnull nullPublished in: Journal of neurology, neurosurgery, and psychiatry (2023)
Compared with treating all patients, CTP-based selection for EVT at the optimised ischaemic core volume (ICV≥110 mL) or core-penumbra mismatch ratio (MMR≤1.4) thresholds resulted in losses of health (median ΔQALYs for ICV≥110 mL: -3.3 (IQR: -5.9 to -1.1), for MMR≤1.4: 0.0 (IQR: -1.3 to 0.0)) with median ΔCosts for ICV≥110 mL of -€348 966 (IQR: -€712 406 to -€51 158) and for MMR≤1.4 of €266 513 (IQR: €229 403 to €380 110)) per 1000 patients. Sensitivity analyses did not yield any scenarios for CTP-based selection of patients for EVT that were cost-effective for improving health, including patients aged ≥80 years CONCLUSION: In EVT-eligible patients presenting within 6 hours after symptom onset, excluding patients based on CTP parameters was not cost-effective and could potentially harm patients.