J Stroke.  2022 Jan;24(1):138-147. 10.5853/jos.2021.01606.

Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study

• Kunz WG
• Sporns PB
• Psychogios MN
• Fiehler J
• Chapot R
• Dorn F
• Grams A
• Morotti A
• Musolino P
• Lee S
• Kemmling A
• Henkes H
• Nikoubashman O
• Wiesmann M
• Jensen-Kondering U
• Möhlenbruch M
• Schlamann M
• Marik W
• Schob S
• Wendl C
• Turowski B
• Götz F
• Kaiser D
• Dimitriadis K
• Gersing A
• Liebig T
• Ricke J
• Reidler P
• Wildgruber M
• Mönch S
• for the Save ChildS Investigators

• KMID: 2525339
• DOI: http://doi.org/10.5853/jos.2021.01606

Abstract

Background and Purpose
The Save ChildS Study demonstrated that endovascular thrombectomy (EVT) is a safe treatment option for pediatric stroke patients with large vessel occlusions (LVOs) with high recanalization rates. Our aim was to determine the long-term cost, health consequences and cost-effectiveness of EVT in this patient population.
Methods
In this retrospective study, a decision-analytic Markov model estimated lifetime costs and quality-adjusted life years (QALYs). Early outcome parameters were based on the entire Save ChildS Study to model the EVT group. As no randomized data exist, the Save ChildS patient subgroup with unsuccessful recanalization was used to model the standard of care group. For modeling of lifetime estimates, pediatric and adult input parameters were obtained from the current literature. The analysis was conducted in a United States setting applying healthcare and societal perspectives. Probabilistic sensitivity analyses were performed. The willingness-to-pay threshold was set to $100,000 per QALY.
Results
The model results yielded EVT as the dominant (cost-effective as well as cost-saving) strategy for pediatric stroke patients. The incremental effectiveness for the average age of 11.3 years at first stroke in the Save ChildS Study was determined as an additional 4.02 lifetime QALYs, with lifetime cost-savings that amounted to $169,982 from a healthcare perspective and $254,110 when applying a societal perspective. Acceptability rates for EVT were 96.60% and 96.66% for the healthcare and societal perspectives.
Conclusions
EVT for pediatric stroke patients with LVOs resulted in added QALY and reduced lifetime costs. Based on the available data in the Save ChildS Study, EVT is very likely to be a cost-effective treatment strategy for childhood stroke.

Keyword

Pediatrics; Stroke; Thrombectomy; Cost-benefit analysis

Figure

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  Figure 1. Model structure. mRS, modified Rankin Scale.

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  Figure 2. Save ChildS Study outcomes by recanalization grade. Pediatric stroke outcomes on the modified Rankin Scale during hospital discharge stratified by modified Thrombolysis in Cerebral Infarction (mTICI) scores. The mTICI 0–3 group represents all patients in the Save ChildS study and was used to model outcomes of the thrombectomy group. The mTICI 0–2a group represents patients with unsuccessful recanalization; these outcomes were used to model the standard of care group.

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  Figure 3. Probabilistic sensitivity analysis from the healthcare and societal perspective. Cost-effectiveness planes of incremental costs and incremental effectiveness of endovascular thrombectomy (EVT) versus standard care are shown for the probabilistic sensitivity analysis. Each dot represents one simulation run. The dashed line indicates a willingness-to-pay threshold of $100,000/quality-adjusted life year (QALY). Dots right to this line are considered cost-effective simulation runs. Dots in the right lower quadrant indicate cost-savings combined with incremental QALYs by EVT.

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  Figure 4. Sensitivity analysis of first-year pediatric recurrent stroke rate. Deterministic one-way sensitivity analysis results are shown for the societal perspective, including societal lifetime costs (A), lifetime quality-adjusted life years (QALYs) (B), and incremental net monetary benefit for endovascular thrombectomy (EVT) compared with standard care (SC) (C). Positive incremental net monetary benefit values indicate cost-effectiveness of EVT based on a willingness-to-pay of $100,000/QALY.

Reference

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