A Cost Utility Analysis of Minimally Invasive Surgery with Thrombolysis Compared to Standard Medical Treatment in Spontaneous Intracerebral Haemorrhagic Stroke

Abstract Objectives For the first time this study carried out a cost-utility analysis comparing open surgical repair versus robotic minimally invasive surgical repair for Mitral Regurgitation. The respective benefits and costs of each treatment option gained from data in published literature have been analysed and subsequent suggestions for the allocation of resources and treatment recommendation will be offered. Methods The analysis was performed by including intraoperative and post-operative costs of the interventions and costs of the most prevalent complications associated with each operation. Thus, the Quality Adjusted Life Years (QALYs) calculated will guide the decision of resource allocation by assessing whether the added cost of robotic surgery is justified given the NICE (National institute of Clinical Excellence) threshold of £30,000/QALY. The choice of perspective taken is through the lens of the British National Healthcare System. Results The Incremental cost-effectiveness ratio (ICER) calculated was £4781.44/QALY. This ICER shows that if robotic surgery was to become gold standard, the NHS would be paying £4781.44/QALY gained per patient. Considering robotic surgery is associated with fewer complications for patients but also has a cost per QALY below the NICE threshold of £30,000/QALY, it seems that this is a fitting alternative to open heart mitral valve repair. After a sensitivity analysis accounting for the initial robotic capital investment the ICER resulted to £22,379.94/QALY, still below NICE’s threshold. Conclusion Our results have shown that robotic assisted minimally invasive repair of the mitral valve is a cost-effective option and can be implemented in the British national healthcare setting.

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Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke

International Journal of Stroke ◽

10.1177/1747493019830587 ◽

2019 ◽

Vol 15 (1) ◽

pp. 75-84 ◽

Cited By ~ 3

Author(s):

Elena Pizzo ◽

Maureen Dumba ◽

Kyriakos Lobotesis

Keyword(s):

Ischemic Stroke ◽

Medical Treatment ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Cost Effective ◽

Cost Utility ◽

Cost Utility Analysis ◽

Utility Analysis ◽

Life Years ◽

The Uk

Background Recently, two randomized controlled trials demonstrated the benefit of mechanical thrombectomy performed between 6 and 24 h in acute ischemic stroke. The current economic evidence is supporting the intervention only within 6 h, but extended thrombectomy treatment times may result in better long-term outcomes for a larger cohort of patients. Aims We compared the cost-utility of mechanical thrombectomy in addition to medical treatment versus medical treatment alone performed beyond 6 h from stroke onset in the UK National Health Service (NHS). Methods A cost-utility analysis of mechanical thrombectomy compared to medical treatment was performed using a Markov model that estimates expected costs and quality-adjusted life years (QALYs) over a 20-year time horizon. We present the results of three models using the data from the DEFUSE 3 and DAWN trials and evidence from published sources. Results Over a 20-year period, the incremental cost per QALY of mechanical thrombectomy was $1564 (£1219) when performed after 12 h from onset, $5253 (£4096) after 16 h and $3712 (£2894) after 24 h. The probabilistic sensitivity analysis demonstrated that thrombectomy had a 99.9% probability of being cost-effective at the minimum willingness to pay for a QALY commonly used in the UK. Conclusions The results of this study demonstrate that performing mechanical thrombectomy up to 24 h from acute ischemic stroke symptom onset is still cost-effective, suggesting that this intervention should be implemented by the NHS on the basis of improvement in quality of life as well as economic grounds.

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