title: Cost-effectiveness of two endovascular treatment strategies vs intravenous thrombolysis.
abstract: OBJECTIVE
  To assess the cost-effectiveness of endovascular treatment against intravenous thrombolysis (IVT) when varying assumptions concerning its effectiveness.
  
  
  METHODS
  We developed a health economic model including a hypothetical population consisting of patients with ischemic stroke, admitted within 4.5 h from onset, without contraindications for IVT or intra-arterial treatment (IAT). A decision tree and life table were used to assess 6-month and lifetime costs (in Euros) and effects in quality-adjusted life years treatment with IVT alone, IAT alone, and IVT followed by IAT if the patient did not respond to treatment. Several analyses were performed to explore the impact of considerable uncertainty concerning the clinical effectiveness of endovascular treatment.
  
  
  RESULTS
  Probabilistic sensitivity analysis demonstrated a 54% probability of positive incremental lifetime effectiveness of IVT-IAT vs IVT alone. Sensitivity analyses showed significant variation in outcomes and cost-effectiveness of the included treatment strategies at different model assumptions.
  
  
  CONCLUSIONS
  Acceptable cost-effectiveness of IVT-IAT compared to IVT will only be possible if recanalization rates are sufficiently high (>50%), treatment costs of IVT-IAT do not increase, and complication rates remain similar to those reported in the few randomized studies published to date. Large randomized studies are needed to reduce the uncertainty concerning the effects of endovascular treatment.
authors.affiliation: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, The Netherlands. bouvy@bmg.eur.nl
authors.forename: J C
authors.initials: JC
authors.lastname: Bouvy
authors.forename: P S S
authors.initials: PS
authors.lastname: Fransen
authors.forename: S A
authors.initials: SA
authors.lastname: Baeten
authors.forename: M A
authors.initials: MA
authors.lastname: Koopmanschap
authors.forename: L W
authors.initials: LW
authors.lastname: Niessen
authors.forename: D W J
authors.initials: DW
authors.lastname: Dippel
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000191:economics* / Q000534:rehabilitation / Q000601:surgery; D002548:Cerebral Revascularization / Q000191:economics* / Q000379:methods; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D019468:Disease Management; D057510:Endovascular Procedures / Q000191:economics*; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000191:economics*; D017048:Health Care Costs; D006699:Home Care Services / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D015993:Life Tables; D018803:Models, Economic; D019057:Quality-Adjusted Life Years; D015912:Thrombolytic Therapy / Q000191:economics*; D014057:Tomography, X-Ray Computed / Q000191:economics; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents