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Ischemic stroke
Original research
Cost-effectiveness of endovascular therapy for acute ischemic stroke with large infarct in China
  1. Yuesong Pan1,2,
  2. Xiaochuan Huo1,2,
  3. Aoming Jin2,3,
  4. Thanh N Nguyen4,
  5. Gaoting Ma1,2,
  6. Xu Tong1,2,
  7. Xuelei Zhang1,2,
  8. Feng Gao1,2,
  9. Ning Ma1,2,
  10. Dapeng Mo1,2,
  11. Zeguang Ren1,2,5,
  12. Yongjun Wang1,2,
  13. Zhongrong Miao1,2
  1. 1 Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  2. 2 China National Clinical Research Centre for Neurological Diseases, Beijing, China
  3. 3 Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  4. 4 Department of Neurology and Radiology, Boston Medical Center, Boston, Massachusetts, USA
  5. 5 Department of Neurosurgery, The Affiliated Hospital of Guizhou Medical University, Guizhou, China
  1. Correspondence to Dr Zhongrong Miao, Interventional Neuroradiology, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; zhongrongm{at}163.com

Abstract

Background Endovascular therapy administered within 24 hours has been shown to improve outcomes for patients with acute ischemic stroke with large infarction, but the data on its cost-effectiveness are limited.

Objective To evaluate the cost-effectiveness of endovascular therapy for acute ischemic stroke with large infarction in China, the largest low- and middle-income country.

Methods A short-term decision tree model and a long-term Markov model were used to analyze the cost-effectiveness of endovascular therapy for patients with acute ischemic stroke with large infarction. Outcomes, transition probability, and cost data were obtained from a recent clinical trial and published literature. The benefit of endovascular therapy was assessed by the cost per quality-adjusted life-years (QALYs) gained in the short and long term. Deterministic one-way and probabilistic sensitivity analyses were performed to assess the robustness of the results.

Results Compared with medical management alone, endovascular therapy for acute ischemic stroke with large infarction was found to be cost-effective from the fourth year onward and during a lifetime. In the long term, endovascular therapy yielded a lifetime gain of 1.33 QALYs at an additional cost of ¥73 900 (US$ 11 400), resulting in an incremental cost of ¥55 500 (US$ 8530) per QALY gained. Probabilistic sensitivity analysis showed that endovascular therapy was cost-effective in 99.5% of the simulation runs at a willingness-to-pay threshold of ¥243 000 (3 × gross domestic product per capita of China in 2021) per QALY gained.

Conclusions Endovascular therapy for acute ischemic stroke with large infarction could be cost-effective in China.

  • Stroke
  • Intervention
  • Thrombectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/jnis-2023-020466

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors YP and ZM had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis as the guarantors.Concept and design: YP, ZM. Acquisition, analysis, or interpretation of data: all authors. Drafting of the manuscript: YP, ZM. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: YP, AJ. Obtained funding: YP, ZM. Administrative, technical, or material support: XH, GM, XT, XZ, FG, NM, DM, ZR. Supervision: YW, ZM.

    • Funding This work was supported by grants from the National Key R&D Program of China (No. 2022YFC3602500, 2022YFC3602505), grants from Covidien Healthcare International Trading (Shanghai) Co.,Ltd, Johnson & Johnson MedTech, Genesis MedTech (Shanghai) Co.,Ltd. and Shanghai HeartCare Medical Technology Co., Ltd.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.