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Cost effectiveness of patient selection based on advanced imaging for patient with acute ischemic stroke
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Barone, Dean. Cost effectiveness of patient selection based on advanced imaging for patient with acute ischemic stroke. Retrieved from https://doi.org/doi:10.7282/t3-kw0p-gp71

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TitleCost effectiveness of patient selection based on advanced imaging for patient with acute ischemic stroke
NameBarone, Dean (author); Coffman, Fredrick (chair); Parrott, James Scott (internal member); Jethwa, Pinakin R. (outside member); Rutgers University; School of Health Professions
Date Created2019
Other Date2019-05 (degree)
SubjectAcute Ischemic Stroke, Biomedical Informatics, Cerebrovascular disease -- Patients, Diagnostic imaging -- Cost effectiveness, Cerebral ischemia
Extent1 online resource (xii, 245 pages) : illustrations
DescriptionBackground: Since 1996, the treatment of acute ischemic stroke with Alteplase (rt-PA) has been based on time after an acute ischemic event. In 2015, thrombectomy procedures were re-introduced to treat strokes with time remaining the principal factor in the decision to treat. More recently, studies have increased the time of treatment with the assistance of advanced imaging, but time continues to be the most important aspect of the determination to treat. As advanced imaging provides significant data on the patient’s current condition, this research was designed to evaluate the cost effectiveness of treating acute ischemic stroke relying on advanced imaging as the primary determinant of patient treatment in comparison to the standard of care designated by the American Heart Association (AHA)/American Stroke Association (ASA) which relies primarily on time.
Methods: A decision tree model was built using TreeAge Pro (TreeAge Pro software (Version: 2017; Build-Id: 17.1.1.0-v20170211)) to evaluate the cost effectiveness of treating acute ischemic stroke. The standard of care for acute ischemic stroke is based on the AHA/ASA guidelines and an algorithm that was developed using advanced imaging to determine treatment instead of time was compared. The data were taken from previous studies associated with the treatment of acute ischemic stroke for outcomes and utilities and from the Centers for Medicare and Medicaid Services for the treatment cost of acute ischemic stroke. After the completion of the base case scenario, a Probability Sensitivity Analysis with Triangular distribution was performed.
Results: Although the incremental cost per patient utilizing the scenario of advanced imaging (CT/CTA/CTP) is $17,049.00 more than utilizing the scenario of time (CT), the increase in effectiveness is 0.58 Life Years, the incremental cost-effectiveness ratio (ICER) of $29,149.00, the Net Monetary Benefit (NMB) of $277,873.00, and the cost per unit effectiveness (C/E) of $5,946.00 favoring the scenario of advanced imaging (CT/CTA/CTP) over the scenario of time (CT), making the scenario of advanced imaging (CT/CTA/CTP) more cost-effective than the scenario of time (CT). The probability sensitivity analysis with 10,000 iterations and a Willingness-to-Pay threshold of $50,000.00 was performed reporting an incremental cost-effectiveness ratio (ICER) proportion of 73.48% in favor of the reference or base case which favored the scenario of advanced imaging (CT/CTA/CTP).
Conclusion: It is cost effective to select patients for stroke intervention based on advanced imaging versus time.
NotePh.D.
NoteIncludes bibliographical references
Genretheses, ETD doctoral
Persistent URLhttps://doi.org/doi:10.7282/t3-kw0p-gp71
LanguageEnglish
CollectionSchool of Health Professions ETD Collection
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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