Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke Results from the SWIFT-PRIME Trial (Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

SWIFT-PRIME Investigators

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background and Purpose-Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. Methods-In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors. Results-Index hospitalization costs were $17 183 per patient higher for SST+tPA than for tPA ($45 761 versus $28 578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11 270 versus $16 174; P=0.014); total 90-day costs remained higher with SST+tPA ($57 031 versus $44 752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23 203 per patient and was economically dominant when compared with tPA in 90% of bootstrap replicates. Conclusions-Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.

Original languageEnglish (US)
Pages (from-to)379-387
Number of pages9
JournalStroke
Volume48
Issue number2
DOIs
StatePublished - Feb 1 2017

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Thrombectomy
Cost-Benefit Analysis
Stents
Stroke
Costs and Cost Analysis
Quality-Adjusted Life Years
Life Expectancy
Health Care Costs
Therapeutics
Clinical Trials
Cost Savings
Tissue Plasminogen Activator
Survivors
Hospitalization
Economics
Quality of Life
Weights and Measures

Keywords

  • quality-adjusted life years
  • stents
  • stroke
  • thrombectomy
  • tissue-type plasminogen activator

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

@article{7dfd2f1a753f4838b1232e1527172fd3,
title = "Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke Results from the SWIFT-PRIME Trial (Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)",
abstract = "Background and Purpose-Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. Methods-In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors. Results-Index hospitalization costs were $17 183 per patient higher for SST+tPA than for tPA ($45 761 versus $28 578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11 270 versus $16 174; P=0.014); total 90-day costs remained higher with SST+tPA ($57 031 versus $44 752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23 203 per patient and was economically dominant when compared with tPA in 90{\%} of bootstrap replicates. Conclusions-Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.",
keywords = "quality-adjusted life years, stents, stroke, thrombectomy, tissue-type plasminogen activator",
author = "{SWIFT-PRIME Investigators} and Shireman, {Theresa I.} and Kaijun Wang and Saver, {Jeffrey L.} and Mayank Goyal and Alain Bonaf{\'e} and Diener, {Hans Christoph} and Levy, {Elad I.} and Pereira, {Vitor M.} and Albers, {Gregory W.} and Christophe Cognard and Werner Hacke and Olav Jansen and Jovin, {Tudor G.} and Mattle, {Heinrich P.} and Nogueira, {Raul G.} and Siddiqui, {Adnan H.} and Yavagal, {Dileep R} and Devlin, {Thomas G.} and Lopes, {Demetrius K.} and Reddy, {Vivek K.} and {De Rochemont}, {Richard Du Mesnil} and Reza Jahan and Vilain, {Katherine A.} and John House and Lee, {Jin Moo} and Cohen, {David J.}",
year = "2017",
month = "2",
day = "1",
doi = "10.1161/STROKEAHA.116.014735",
language = "English (US)",
volume = "48",
pages = "379--387",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke Results from the SWIFT-PRIME Trial (Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

AU - SWIFT-PRIME Investigators

AU - Shireman, Theresa I.

AU - Wang, Kaijun

AU - Saver, Jeffrey L.

AU - Goyal, Mayank

AU - Bonafé, Alain

AU - Diener, Hans Christoph

AU - Levy, Elad I.

AU - Pereira, Vitor M.

AU - Albers, Gregory W.

AU - Cognard, Christophe

AU - Hacke, Werner

AU - Jansen, Olav

AU - Jovin, Tudor G.

AU - Mattle, Heinrich P.

AU - Nogueira, Raul G.

AU - Siddiqui, Adnan H.

AU - Yavagal, Dileep R

AU - Devlin, Thomas G.

AU - Lopes, Demetrius K.

AU - Reddy, Vivek K.

AU - De Rochemont, Richard Du Mesnil

AU - Jahan, Reza

AU - Vilain, Katherine A.

AU - House, John

AU - Lee, Jin Moo

AU - Cohen, David J.

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background and Purpose-Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. Methods-In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors. Results-Index hospitalization costs were $17 183 per patient higher for SST+tPA than for tPA ($45 761 versus $28 578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11 270 versus $16 174; P=0.014); total 90-day costs remained higher with SST+tPA ($57 031 versus $44 752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23 203 per patient and was economically dominant when compared with tPA in 90% of bootstrap replicates. Conclusions-Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.

AB - Background and Purpose-Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions. Methods-In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors. Results-Index hospitalization costs were $17 183 per patient higher for SST+tPA than for tPA ($45 761 versus $28 578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11 270 versus $16 174; P=0.014); total 90-day costs remained higher with SST+tPA ($57 031 versus $44 752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23 203 per patient and was economically dominant when compared with tPA in 90% of bootstrap replicates. Conclusions-Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.

KW - quality-adjusted life years

KW - stents

KW - stroke

KW - thrombectomy

KW - tissue-type plasminogen activator

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U2 - 10.1161/STROKEAHA.116.014735

DO - 10.1161/STROKEAHA.116.014735

M3 - Article

C2 - 28028150

AN - SCOPUS:85007436585

VL - 48

SP - 379

EP - 387

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 2

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