TY - JOUR

T1 - Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke

T2 - An Analysis of the Save ChildS Study

AU - Kunz, Wolfgang G.

AU - Sporns, Peter B.

AU - Psychogios, Marios N.

AU - Fiehler, Jens

AU - Chapot, Rene

AU - Dorn, Franziska

AU - Grams, Astrid

AU - Morotti, Andrea

AU - Musolino, Patricia

AU - Lee, Sarah

AU - Kemmling, Andre

AU - Henkes, Hans

AU - Nikoubashman, Omid

AU - Wiesmann, Martin

AU - Jensen-Kondering, Ulf

AU - Moehlenbruch, Markus

AU - Schlamann, Marc

AU - Marik, Wolfgang

AU - Schob, Stefan

AU - Wendl, Christina

AU - Turowski, Bernd

AU - Goetz, Friedrich

AU - Kaiser, Daniel

AU - Dimitriadis, Konstantinos

AU - Gersing, Alexandra

AU - Liebig, Thomas

AU - Ricke, Jens

AU - Reidler, Paul

AU - Wildgruber, Moritz

AU - Moench, Sebastian

AU - Save ChildS Investigators

PY - 2022/1

Y1 - 2022/1

N2 - 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 sub-group with unsuccessful recanalization was used to model the standard of care group. For model -ing of lifetime estimates, pediatric and adult input parameters were obtained from the current lit- erature. 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.

AB - 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 sub-group with unsuccessful recanalization was used to model the standard of care group. For model -ing of lifetime estimates, pediatric and adult input parameters were obtained from the current lit- erature. 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.

KW - Pediatrics

KW - Stroke

KW - Thrombectomy

KW - Cost-benefit analysis

KW - ACUTE ISCHEMIC-STROKE

KW - QUALITY-OF-LIFE

KW - RECURRENT STROKE

KW - MECHANICAL THROMBECTOMY

KW - PLASMINOGEN-ACTIVATOR

KW - HOSPITAL COSTS

KW - UNITED-STATES

KW - RISK-FACTORS

KW - CARE COSTS

KW - POPULATION

U2 - 10.5853/jos.2021.01606

DO - 10.5853/jos.2021.01606

M3 - Journal article

C2 - 35135067

VL - 24

SP - 138

EP - 147

JO - Journal of Stroke

JF - Journal of Stroke

SN - 2287-6391

IS - 1

ER -