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Cost effectiveness of patient selection based on advanced imaging for patient with acute ischemic stroke

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Title
Cost effectiveness of patient selection based on advanced imaging for patient with acute ischemic stroke
Name (type = personal)
NamePart (type = family)
Barone
NamePart (type = given)
Dean
NamePart (type = date)
1971-
DisplayForm
Dean Barone
Role
RoleTerm (authority = RULIB)
author
Name (type = personal)
NamePart (type = family)
Coffman
NamePart (type = given)
Fredrick
DisplayForm
Fredrick Coffman
Affiliation
Advisory Committee
Role
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chair
Name (type = personal)
NamePart (type = family)
Parrott
NamePart (type = given)
James Scott
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James Scott Parrott
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Advisory Committee
Role
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internal member
Name (type = personal)
NamePart (type = family)
Jethwa
NamePart (type = given)
Pinakin R.
DisplayForm
Pinakin R. Jethwa
Affiliation
Advisory Committee
Role
RoleTerm (authority = RULIB)
outside member
Name (type = corporate)
NamePart
Rutgers University
Role
RoleTerm (authority = RULIB)
degree grantor
Name (type = corporate)
NamePart
School of Health Professions
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RoleTerm (authority = RULIB)
school
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Text
Genre (authority = marcgt)
theses
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DateCreated (encoding = w3cdtf); (qualifier = exact)
2019
DateOther (encoding = w3cdtf); (qualifier = exact); (type = degree)
2019-05
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2019
Language
LanguageTerm (authority = ISO 639-3:2007); (type = text)
English
Abstract
Background: 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.
Subject (authority = local)
Topic
Acute Ischemic Stroke
Subject (authority = RUETD)
Topic
Biomedical Informatics
Subject (authority = ETD-LCSH)
Topic
Cerebrovascular disease -- Patients
Subject (authority = ETD-LCSH)
Topic
Diagnostic imaging -- Cost effectiveness
RelatedItem (type = host)
TitleInfo
Title
Rutgers University Electronic Theses and Dissertations
Identifier (type = RULIB)
ETD
Identifier
ETD_9932
PhysicalDescription
Form (authority = gmd)
InternetMediaType
application/pdf
InternetMediaType
text/xml
Extent
1 online resource (xii, 245 pages) : illustrations
Note (type = degree)
Ph.D.
Note (type = bibliography)
Includes bibliographical references
Subject (authority = ETD-LCSH)
Topic
Cerebral ischemia
RelatedItem (type = host)
TitleInfo
Title
School of Health Professions ETD Collection
Identifier (type = local)
rucore10007400001
Location
PhysicalLocation (authority = marcorg); (displayLabel = Rutgers, The State University of New Jersey)
NjNbRU
Identifier (type = doi)
doi:10.7282/t3-kw0p-gp71
Genre (authority = ExL-Esploro)
ETD doctoral
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Rights

RightsDeclaration (ID = rulibRdec0006)
The author owns the copyright to this work.
RightsHolder (type = personal)
Name
FamilyName
Barone
GivenName
Dean
Role
Copyright Holder
RightsEvent
Type
Permission or license
DateTime (encoding = w3cdtf); (qualifier = exact); (point = start)
2019-04-29 19:44:13
AssociatedEntity
Name
Dean Barone
Role
Copyright holder
Affiliation
Rutgers University. School of Health Professions
AssociatedObject
Type
License
Name
Author Agreement License
Detail
I hereby grant to the Rutgers University Libraries and to my school the non-exclusive right to archive, reproduce and distribute my thesis or dissertation, in whole or in part, and/or my abstract, in whole or in part, in and from an electronic format, subject to the release date subsequently stipulated in this submittal form and approved by my school. I represent and stipulate that the thesis or dissertation and its abstract are my original work, that they do not infringe or violate any rights of others, and that I make these grants as the sole owner of the rights to my thesis or dissertation and its abstract. I represent that I have obtained written permissions, when necessary, from the owner(s) of each third party copyrighted matter to be included in my thesis or dissertation and will supply copies of such upon request by my school. I acknowledge that RU ETD and my school will not distribute my thesis or dissertation or its abstract if, in their reasonable judgment, they believe all such rights have not been secured. I acknowledge that I retain ownership rights to the copyright of my work. I also retain the right to use all or part of this thesis or dissertation in future works, such as articles or books.
Copyright
Status
Copyright protected
Availability
Status
Open
Reason
Permission or license
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windows xp
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2019-05-06T16:07:21
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2019-05-06T16:34:09
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Microsoft® Word for Office 365
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