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Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China

BACKGROUND: Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China. METHOD...

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Autores principales: Ni, Weiyi, Kunz, Wolfgang G., Goyal, Mayank, Chen, Lijin, Jiang, Yawen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740348/
https://www.ncbi.nlm.nih.gov/pubmed/34993675
http://dx.doi.org/10.1186/s13561-021-00352-w
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author Ni, Weiyi
Kunz, Wolfgang G.
Goyal, Mayank
Chen, Lijin
Jiang, Yawen
author_facet Ni, Weiyi
Kunz, Wolfgang G.
Goyal, Mayank
Chen, Lijin
Jiang, Yawen
author_sort Ni, Weiyi
collection PubMed
description BACKGROUND: Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China. METHODS: A model combining a short-term decision tree and long-term Markov health state transition matrix was constructed. For each time window of symptom onset to EVT, the probability of receiving EVT or non-EVT treatment was varied, thereby varying clinical outcomes and healthcare costs. Clinical outcomes and cost data were derived from clinical trials and literature. Incremental cost-effectiveness ratio and incremental net monetary benefits were simulated. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model. The willingness-to-pay threshold per quality-adjusted life-year (QALY) was set to ¥71,000 ($10,281). RESULTS: EVT performed between 61 and 120 min after the stroke onset was most cost-effective comparing to other time windows to perform EVT among AIS patients in China, with an ICER of ¥16,409/QALY ($2376) for performing EVT at 61–120 min versus the time window of 301–360 min. Each hour delay in EVT resulted in an average loss of 0.45 QALYs and 165.02 healthy days, with an average net monetary loss of ¥15,105 ($2187). CONCLUSIONS: Earlier treatment of acute ischemic stroke patients with EVT in China increases lifetime QALYs and the economic value of care without any net increase in lifetime costs. Thus, healthcare policies should aim to improve efficiency of pre-hospital and in-hospital workflow processes to reduce the onset-to-puncture duration in China.
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spelling pubmed-87403482022-01-07 Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China Ni, Weiyi Kunz, Wolfgang G. Goyal, Mayank Chen, Lijin Jiang, Yawen Health Econ Rev Research BACKGROUND: Although endovascular therapy (EVT) improves clinical outcomes in patients with acute ischemic stroke, the time of EVT initiation significantly influences clinical outcomes and healthcare costs. This study evaluated the impact of EVT treatment delay on cost-effectiveness in China. METHODS: A model combining a short-term decision tree and long-term Markov health state transition matrix was constructed. For each time window of symptom onset to EVT, the probability of receiving EVT or non-EVT treatment was varied, thereby varying clinical outcomes and healthcare costs. Clinical outcomes and cost data were derived from clinical trials and literature. Incremental cost-effectiveness ratio and incremental net monetary benefits were simulated. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the model. The willingness-to-pay threshold per quality-adjusted life-year (QALY) was set to ¥71,000 ($10,281). RESULTS: EVT performed between 61 and 120 min after the stroke onset was most cost-effective comparing to other time windows to perform EVT among AIS patients in China, with an ICER of ¥16,409/QALY ($2376) for performing EVT at 61–120 min versus the time window of 301–360 min. Each hour delay in EVT resulted in an average loss of 0.45 QALYs and 165.02 healthy days, with an average net monetary loss of ¥15,105 ($2187). CONCLUSIONS: Earlier treatment of acute ischemic stroke patients with EVT in China increases lifetime QALYs and the economic value of care without any net increase in lifetime costs. Thus, healthcare policies should aim to improve efficiency of pre-hospital and in-hospital workflow processes to reduce the onset-to-puncture duration in China. Springer Berlin Heidelberg 2022-01-06 /pmc/articles/PMC8740348/ /pubmed/34993675 http://dx.doi.org/10.1186/s13561-021-00352-w Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Ni, Weiyi
Kunz, Wolfgang G.
Goyal, Mayank
Chen, Lijin
Jiang, Yawen
Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China
title Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China
title_full Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China
title_fullStr Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China
title_full_unstemmed Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China
title_short Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China
title_sort quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in china
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740348/
https://www.ncbi.nlm.nih.gov/pubmed/34993675
http://dx.doi.org/10.1186/s13561-021-00352-w
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