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

Research output: Contribution to journalResearch articleContributedpeer-review

Contributors

  • Wolfgang G. Kunz - , Ludwig Maximilian University of Munich (Author)
  • Peter B. Sporns - , University of Basel, University of Hamburg (Author)
  • Marios N. Psychogios - , University of Basel (Author)
  • Jens Fiehler - , University of Hamburg (Author)
  • René Chapot - , Alfried Krupp Krankenhaus (Author)
  • Franziska Dorn - , University of Bonn (Author)
  • Astrid Grams - , Innsbruck Medical University (Author)
  • Andrea Morotti - , University of Brescia (Author)
  • Patricia Musolino - , Harvard University (Author)
  • Sarah Lee - , Stanford University (Author)
  • André Kemmling - , University of Marburg (Author)
  • Hans Henkes - , Klinikum Stuttgart (Author)
  • Omid Nikoubashman - , University Hospital Aachen (Author)
  • Martin Wiesmann - , University Hospital Aachen (Author)
  • Ulf Jensen-Kondering - , Kiel University (Author)
  • Markus Möhlenbruch - , Heidelberg University  (Author)
  • Marc Schlamann - , University of Cologne (Author)
  • Wolfgang Marik - , Medical University of Vienna (Author)
  • Stefan Schob - , Leipzig University (Author)
  • Christina Wendl - , University of Regensburg (Author)
  • Bernd Turowski - , Heinrich Heine University Düsseldorf (Author)
  • Friedrich Götz - , Hannover Medical School (MHH) (Author)
  • Daniel Kaiser - , Institute and Polyclinic of Diagnostic and Interventional Neuroradiology, University Hospital Carl Gustav Carus Dresden, TUD Dresden University of Technology (Author)
  • Konstantinos Dimitriadis - , Ludwig Maximilian University of Munich (Author)
  • Alexandra Gersing - , Ludwig Maximilian University of Munich (Author)
  • Thomas Liebig - , Ludwig Maximilian University of Munich (Author)
  • Jens Ricke - , Ludwig Maximilian University of Munich (Author)
  • Paul Reidler - , Ludwig Maximilian University of Munich (Author)
  • Moritz Wildgruber - , Ludwig Maximilian University of Munich (Author)
  • Sebastian Mönch - , Ludwig Maximilian University of Munich (Author)
  • For The Save - (Author)

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 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.

Details

Original languageEnglish
Pages (from-to)138-147
Number of pages10
Journal Journal of stroke : JoS
Volume24
Issue number1
Publication statusPublished - Jan 2022
Peer-reviewedYes

External IDs

ORCID /0000-0001-5258-0025/work/146644935

Keywords

Keywords

  • Cost-benefit analysis, Pediatrics, Stroke, Thrombectomy

Library keywords