scholarly journals Who should get the scarce ICU bed? The US public’s view on triage in the time of COVID-19

2022 ◽  
pp. emermed-2021-211297
Author(s):  
Helena C Cardenas ◽  
Richard T Carson ◽  
Michael Hanemann ◽  
Jordan J Louviere ◽  
Dale Whittington
Keyword(s):  
Age Groups ◽  
Young Patients ◽  
Public Place ◽  
Old Patients ◽  
Probability Of Survival ◽  
Life Years ◽  
The Us ◽  
Nationally Representative ◽  
Choice Tasks ◽  
Triage Decisions

ObjectiveTo determine the relative importance members of the US public place on different patient attributes in triage decisions about who should receive the last available intensive care unit (ICU) bed.MethodsA discrete choice experiment was conducted with a nationally representative sample of 2000 respondents from the YouGov internet panel of US households. Respondents chose which of three hypothetical patients with COVID-19 should receive an ICU bed if only one were available. The three patients differed in age, gender, Alzheimer’s-like disability and probability of survival if the patient received the ICU bed. An experimental design varied the values of the four attributes of the three hypothetical patients with COVID-19 that a respondent saw in four choice tasks.ResultsThe most important patient attribute to respondents was the probability the patient survives COVID-19 if they get the ICU bed (OR CI: 4.41 to 6.91). There was heterogeneity among different age groups of respondents about how much age of the patient mattered. Respondents under 30 years of age were more likely to choose young patients and old patients, and less likely to select patients aged 40–60 years old. For respondents in the age group 30–49 years old, as the age of the patient declined, their preference for saving the patient declined modestly in a linear fashion.ConclusionsRespondents favoured giving the last ICU bed available to the patient with the highest probability of surviving COVID-19. Public opinion suggests a simple guideline for physician choices based on likelihood of survival as opposed to the number of life-years saved. There was heterogeneity among respondents of different age groups for allocating the last ICU bed, as well as to the importance of the patient having an Alzheimer’s-like disability (where religion of the respondent is important) and the gender of the patient (where the gender and racial identity are important).

scholarly journals A Clinicopathological Analysis on Diffuse Midline Glioma in Adults

2021 ◽  
Author(s):  
Xiao Mu Hu ◽  
Xiao Yu Nie ◽  
Kai Lun Xu ◽  
Yin Wang ◽  
Feng Tang ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Time ◽  
Median Survival ◽  
Median Survival Time ◽  
Age Groups ◽  
Young Patients ◽  
Imaging Data ◽  
Wild Type ◽  
Old Patients ◽  
Diffuse Midline Glioma

Abstract Purpose: Diffuse midline glioma (DMG), H3K27M mutant is a new entity that has become widely recognized. However, studies concerning DMG in adult patients remains rare. We did a retrospective study covering the largest amount of patients to date to analyze the clinicopathological characteristics of DMG in adult. Methods: We reviewed 117 cases of adult DMG, collected their clinical and imaging data along with pathological results including H3K27M. Summarized their features and the connection with overall survival in different age groups.Results: Among 117 cases, most tumors were located at the thalamus, 39 patients had H3K27M mutation, of whom 38 demonstrated down regulation of H3K27me3. The average overall survival of H3K27M-mutant gliomas was 13 months, while that of 78 H3K27M wild-type gliomas were 11.8 months. For young patients (age＜35), The median survival time of the H3K27M-mutant was 20.1 months, while that of the H3K27M wild-type was 39.5 months. For older patients (age≥35), the median survival time of the H3K27M-mutant was 22.3 months, while that of the H3K27M wild-type was 17.1 months. The OS of patients who received biopsies, subtotal resections, and total resections were 15.8, 17.6, and 11.6 months respectively. Conclusion: The DMG in adults mainly occurred in the thalamus. H3K27M mutations tend to happen more frequently in young adults, and this genetic alteration results in a worse outcome only in young patients. For old patients, age and the approach of surgery are independent prognostic factors. Patients received biopsy instead of total resection had a better prognosis.

scholarly journals Implications of Achieving TICI 2b Versus TICI 3 Reperfusion in Patients With Ischemic Stroke: A Cost-Effectiveness Analysis

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Xiao Wu ◽  
Dheeraj Gandhi ◽  
Charles C Matouk ◽  
Joseph Schindler ◽  
Danny Hughes ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
Sensitivity Analyses ◽  
Base Case ◽  
Old Patients ◽  
Life Years ◽  
Outcome Differences

Abstract INTRODUCTION The degree of successful reperfusion of large vessel occlusions (LVO) in patients with acute ischemic stroke (AIS) treated by mechanical thrombectomy (MT) is one of the critical and potentially modifiable determinants of clinical outcome. Differences in outcomes between patients with TICI 2b vs TICI 3 reperfusion have recently been highlighted. This study examines the public health and cost implications of achieving TICI 2b vs TICI 3 reperfusion. METHODS A decision-analytic study was performed to estimate the lifetime quality-adjusted life years (QALY) and associated costs based on the degree of reperfusion achieved. The base case calculations and multiple one-way sensitivity analyses were performed for AIS patients with LVO undergoing MT in 3 age groups: 55, 65, and 75 yr old, respectively. RESULTS Within 90 d, achieving TICI 3 results in a cost-saving of $5,258 per patient and health benefit of 7.3 d in perfect health as compared to TICI 2b. In the long-term, for the 3 ages groups (55, 65, and 75 yr old), achieving TICI 3 results in cost savings of $82,965, $51,155, and $31,034 respectively, and health benefits of 2.42 QALYs, 1.92 QALYs, and 1.36 QALYs. Every 1% increase in TICI 3 in 55-yr-old patients at a nation-wide level results in a cost saving of nearly $6.1 million and a health benefit of 176 QALYs. Among 65-yr-old patients, the corresponding cost savings and health benefit are $3.7 million and 176 QALYs, and $2.3 million and 99 QALYS for 75-yr-old patients. CONCLUSION There are substantial cost and health implications of achieving complete vs incomplete reperfusion after EVT. Our study reinforces the need for a more conservative definition of therapy success and treatment approaches to achieve TICI 3 reperfusion.

scholarly journals Who Should Rather Undergo Transesophageal Echocardiography to Determine Stroke Etiology: Young or Elderly Stroke Patients?

2020 ◽  
Vol 11 ◽  
Author(s):  
Christoph Strecker ◽  
Felix Günther ◽  
Andreas Harloff
Keyword(s):  
Secondary Prevention ◽  
Transesophageal Echocardiography ◽  
Treatment Guidelines ◽  
Age Groups ◽  
Cryptogenic Stroke ◽  
Young Patients ◽  
Old Patients ◽  
Stroke Etiology ◽  
Risk Sources ◽  
The Impact

Introduction: The indication of transesophageal echocardiography (TEE) in acute stroke is unclear. Thus, we systematically studied the impact of TEE on determining stroke etiology and secondary prevention in patients of different age-groups with cryptogenic stroke.Methods: Four hundred and eighty five consecutive patients with acute retinal or cerebral ischemia were prospectively included and underwent routine stroke workup including TEE. Stroke etiology was identified according to the TOAST classification and patients were divided in those with determined and cryptogenic stroke etiology without TEE results. Then, the frequency of high- and potential-risk sources in TEE was evaluated in <55, 55–74, and ≥75 year-old patients with cryptogenic stroke etiology.Results: Without TEE, stroke etiology was cryptogenic in 329(67.8%) patients and TEE determined possible etiology in 158(48.4%) of them. In patients aged <55, 55–74, ≥75, TEE detected aortic arch plaques ≥4 mm thickness in 2(1.2%), 37(23.0%), and 33(40.2%) and plaques with superimposed thrombi in 0(0.0%), 5(3.1%), and 7(8.5%); left atrial appendage peak emptying flow velocity ≤30cm/s in 0(0.0%), 1(0.6%), and 2(2.4%), spontaneous echo contrast in 0(0.0%), 1(0.6%), and 6(7.3%), endocarditis in 0(0.0%), 0(0.0%), and 1(1.2%) and patent foramen ovale (PFO) plus atrial septum aneurysm (ASA) in 18(20.9%), 32(19.9%), and 14(17.1%), respectively. TEE changed secondary prevention in 16.4% of these patients following guidelines of 2010/11 and still 9.4% when applying the guidelines of 2020.Conclusions: TEE was highly valuable for determining stroke etiology and influenced individual secondary prevention based on available treatment guidelines and expert opinion in most cases. In young patients the impact of TEE was limited to the detection of septal anomalies. By contrast, in older patients TEE detected high numbers of complex aortic atheroma and potential indicators of paroxysmal atrial fibrillation.

scholarly journals Type 2 diabetes in older patients: an analysis of the DPV and DIVE databases

2020 ◽  
Vol 11 ◽  
pp. 204201882095829
Author(s):  
Gesine van Mark ◽  
Sascha R. Tittel ◽  
Stefan Sziegoleit ◽  
Franz Josef Putz ◽  
Mesut Durmaz ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Older Patients ◽  
Microvascular Complications ◽  
Oldest Old ◽  
Age Groups ◽  
Young Patients ◽  
Severe Hypoglycemia ◽  
Old Patients

Background: The clinical profile differs between old and young patients with type 2 diabetes mellitus (T2DM). We explored, based on a large real-world database, patient and disease characteristics and actual treatment patterns by age. Methods: The analysis was based on the DIVE and DPV registries of patients with T2DM. Patients were analyzed by age groups 50–59 (middle-young), 60–69 (young-old), 70–79 (middle-old), 80–89 (old), and 90 years or more (oldest-old). Results: A total of 396,719 patients were analyzed, of which 17.7% were 50–59 years, 27.7% 60–69 years, 34.3% 70–79 years, 18.3% 80–89 years and 2.0% at least 90 years. We found that (a) T2DM in old and oldest-old patients was characterized much less by the presence of metabolic risk factors such as hypertension, obesity, dyslipidemia and smoking than in younger patients; (b) the HbA1c was much lower in oldest-old than in middle-young patients (7.2 ± 1.6% versus 8.0 ± 2.2%; p < 0.001), but it was associated with higher proportions of patients with severe hypoglycemia (7.0 versus 1.6%; p < 0.001); (c) this was potentially associated with the higher and increasing rates of insulin use in older patients (from 17.6% to 37.6%, p < 0.001) and the particular comorbidity profile of these patients, for example, chronic kidney disease (CKD); (d) patients with late diabetes onset had lower HbA1c values, lower bodyweight and less cardiovascular risk factors; (e) patients with a longer diabetes duration had a considerable increase in macrovascular and even more microvascular complications. Conclusion: In very old patients there is a need for frequent careful routine assessment and a tailored pharmacotherapy in which patient safety is much more important than blood-glucose-lowering efficacy.

scholarly journals Serum Total Testosterone Concentrations in the US Household Population from the NHANES 2011–2012 Study Population

2015 ◽  
Vol 61 (12) ◽  
pp. 1495-1504 ◽  
Author(s):  
Hubert W Vesper ◽  
Yuesong Wang ◽  
Meghan Vidal ◽  
Julianne Cook Botelho ◽  
Samuel P Caudill
Keyword(s):  
Ethnic Groups ◽  
Mexican American ◽  
Age Groups ◽  
Total Testosterone ◽  
Limited Information ◽  
Serum Samples ◽  
Geometric Means ◽  
Health And Nutrition ◽  
The Us ◽  
Nationally Representative

Abstract BACKGROUND Limited information is available about testosterone concentrations representative of the general US population, especially children, women, and non-Hispanic Asians. METHODS We obtained nationally representative data for total testosterone (totalT), measured with standardized LC-MS/MS, for the US population age 6 years and older from the 2011–2012 National Health and Nutrition Examination Survey (NHANES). We analyzed 6746 serum samples and calculated the geometric means, distribution percentiles, and covariate-adjusted geometric means by age, sex, and race/ethnicity. RESULTS The 10th–90th percentiles of totalT values in adults (≥20 years) was 150–698 ng/dL (5.20–24.2 nmol/L) in men, 7.1–49.8 ng/dL (0.25–1.73 nmol/L) in women, and 1.0–9.5 ng/dL (0.04–0.33 nmol/L) in children (6–10 years old). Differences among race/ethnic groups existed in children and men: covariate-adjusted totalT values in non-Hispanic Asians were highest among children (58% compared to non-Hispanic black children) and lowest among men (12% compared to Mexican-American men). Covariate-adjusted totalT values in men were higher at age 55–60 years compared to ages 35 and 80 years, a pattern different from that observed in previous NHANES cycles. CONCLUSIONS TotalT patterns were different among age groups in men compared with previous NHANES cycles. Covariate-adjusted totalT values peaked at age 55–60 years in men, which appeared to be consistent with the increased use of exogenous testosterone. Differences among race/ethnic groups existed and appeared more pronounced in children than adults.

Treatment patterns and survival outcomes of older patients with advanced pancreatic cancer (APC): A Canadian real-world evidence study.

2021 ◽  
Vol 39 (3_suppl) ◽  
pp. 385-385
Author(s):  
Atul Batra ◽  
Ravi Ramjeesingh ◽  
Brandon M. Meyers ◽  
Michael M. Vickers ◽  
Rachel Anne Goodwin ◽  
...  
Keyword(s):  
Metastatic Disease ◽  
Real World ◽  
Geriatric Patients ◽  
Group Performance ◽  
Age Groups ◽  
Young Patients ◽  
Intensive Chemotherapy ◽  
Old Patients ◽  
Ecog Ps ◽  
Young Old

385 Background: We aimed to compare chemotherapy regimens used and overall survival (OS) among geriatric patients (≥ 75 years) with APC as compared to old (65-74 years) and young (< 65 years) patients with APC. Methods: In this retrospective population-based analysis, we identified patients with APC (defined as inoperable/metastatic disease) from 5 large provinces in Canada who were diagnosed from 2011 to 2016. Kaplan-Meier curves were plotted to derive OS and multivariable Cox regression models were constructed to determine the associations of different age groups on OS. Results: We included 636 patients diagnosed with APC of whom 258 (40.6%), 247 (38.8%) and 131 (20.6%) were young, old and geriatric. Approximately half (45.7%) of all patients were women. Eastern Cooperative Oncology Group performance status (ECOG PS) was known in 508 patients at diagnosis among whom 62.2% were 0-1 and 37.8% were 2+. ECOG PS was more likely to be 2+ in the geriatric group (46.8% vs 41.1% vs 31.3%; P = 0.017). Most patients (95.8%) had metastatic disease while the remaining patients had inoperable locally advanced disease. Within the study cohort, 38.7% received chemotherapy. Treatment rates differed based on age: 41.9% in young patients, 40.9% in old patients and 28.2% in geriatric patients (P = 0.02). Choice of first-line chemotherapy varied and included FOLFIRINOX (F) in 99 (40.2%), gemcitabine and nab-paclitaxel (GN) in 91 (37.0%) and gemcitabine (G) in 56 (22.8%). F, GN and G were administered in 27.0%, 32.4% and 40.5% of geriatric patients, 40.6%, 32.7% and 26.7% of old patients, and 44.4%, 42.6% and 13.0% of young patients, respectively (P = 0.007). After adjusting for baseline factors, both geriatric (odds ratio [OR], 0.70; 95% confidence interval [CI], 0.42-1.17; P = 0.175) and old patients were as likely to receive chemotherapy (OR, 1.04; 95% CI, 0.70-1.56; P = 0.815) as their young counterparts. The median OS was 7.1 (6.3-8.4), 6.7 (5.5-8.9) and 5.3 (4.3-6.8) months in young, old and geriatric patients, respectively. After adjusting for baseline variables, both geriatric (hazard ratio [HR], 1.25; 95% CI, 0.96-1.62; P = 0.101) and old patients (HR, 1.16; 95% CI, 0.94-1.42; P = 0.171) experienced similar OS as young patients. ECOG PS 2+ at presentation was associated with worse OS as was treatment with G. Conclusions: Overall treatment rates for APC are low in the real world. The poor OS in geriatric patients with APC is driven by poor PS and use of less intensive chemotherapy. Age alone should not be considered a contraindication for more intensive chemotherapy since treatment benefit is observed across all age groups. [Table: see text]

Cost-effectiveness of denosumab (Dmab) versus zoledronic acid (ZA) for prevention of skeletal-related events (SREs) in patients (pts) with castrate-resistant prostate cancer (CRPC) and bone metastases (BM).

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 59-59
Author(s):  
Michael E. Rader ◽  
Mark Danese ◽  
Ze Cong ◽  
Marc Halperin ◽  
Yi Qian ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Real World ◽  
Relative Rate ◽  
Lifetime Cost ◽  
Cost Benefit ◽  
Cost Effective ◽  
Claims Database ◽  
Life Years ◽  
The Us ◽  
Nationally Representative

59 Background: It has become more important to understand the incremental cost/benefit of new medicines as healthcare costs rise. Subcutaneous Dmab is superior to intravenous ZA for prevention of SREs in pts with CRPC and BM (Fizazi, 2011). In addition, a lower proportion of pts receiving Dmab progressed to moderate/severe pain than those receiving ZA (Brown, 2011). Dmab can be used in pts regardless of renal status or concomitant use of nephrotoxic drugs. These analyses assess the lifetime, real world cost-effectiveness of Dmab vs ZA in pts with CRPC and BM from a US managed care perspective. Methods: A lifetime Markov model was developed to estimate SREs, quality adjusted life-years (QALYs), and costs. The relative rate reduction in SREs for Dmab vs ZA was based on a large head-to-head phase 3 trial (N=1,901). The real world SRE rate in ZA pts was derived from a large commercial claims database analysis (Hatoum, 2008). SRE QALY decrements were estimated using the time trade-off method (Matza, 2011). SRE costs were estimated from a nationally representative commercial claims database (Barlev, 2010). Wholesale acquisition drug cost (Analysource, 2011), drug administration, and renal monitoring costs (National Fee Analyzer, 2011) were included. Compliance and mortality were assumed to be the same in both groups. Costs and QALYs were discounted at 3% annually. Results: With a median pt survival of 1.7 years, Dmab reduced the number of SREs and increased pts’ QALY vs ZA. The lifetime cost/pt on Dmab was $7,430 higher than ZA. Cost/QALY gained was $65,134, commonly considered good value based on oncologists’ implied threshold in the US (Nadler, 2006). Cost/SRE avoided was $9,212. Conclusions: Dmab is cost-effective in preventing SREs in pts with CRPC and BM compared with ZA in the US. The overall value of Dmab is based on superior efficacy and more efficient administration. [Table: see text]

Incidence patterns of early onset colon cancer by race and stage in the US.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e18168-e18168
Author(s):  
Nishi Shah ◽  
Ana Acuna-Villaorduna ◽  
Sanjay Goel
Keyword(s):  
Colon Cancer ◽  
American Indians ◽  
Early Onset ◽  
Age Groups ◽  
Young Patients ◽  
Cancer Registries ◽  
Age Group ◽  
Annual Percent Change ◽  
Percent Change ◽  
The Us

e18168 Background: Several studies show that incidence of colorectal cancer is increasing among young individuals. However, information on incidence of early onset colon cancer by race and stage is lacking. Methods: We analyzed incidence of colon cancer using National Program of Cancer Registries database which covers 99% of the US population. We identified colon cancer using ICD-O-3 code 8000-9049, 9056-9139, 9141-9589, along with the variable for site from cecum to sigmoid colon for years 2001 to 2015. SEER*Stat was used to calculate age-adjusted rates, trends and annual percent change. Results: Age adjusted incidence rate for colon is 31.2 cases per 100,000 among the entire population. Incidence in the age group of 15-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, 80+ years is 2.4, 14.3, 39.8, 86, 165.8, 232.3 per 100,000 respectively. The distribution of colon cancer by race for age groups is listed in table. When evaluating the incidence trend in each race for early onset colon cancer, the trend shows a rise in whites for both age groups (Annual Percent Change [APC] 3.4%, 1.5% for 15-39 years, 40-49 years of age respectively, p < 0.05). The trend in blacks on the other hand shows a rise of 1.2% (p < 0.05) in 15-39 years of age and a small but statistically significant decrease in incidence in 40-49 years of 0.5% (p < 0.05). In Asian Pacific Islanders (API) and American-Indians or Alaskan Natives (AI), the trend is not significant for either age groups. In the age groups above 50 years, the trend shows a decrease in incidence of colon cancer in all races. The rise in incidence for colon cancer in 15-39 years age group appears higher in localized disease as compared to metastatic disease (6.5% vs 2.8% for localized vs distant site of disease). Conclusions: This study highlights differences in incidence of early onset colon cancer among young patients by race and stage. Although there have been more cases of early onset colon cancers in blacks, the rise in incidence is higher in whites. With colonoscopy, there has been decrease in incidence of colon cancer for patients > 50 years for all races and stages. [Table: see text]

scholarly journals Association between age and infection in patients with acute ST-elevation myocardial infarction

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Magdy Algowhary
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Analyses ◽  
Age Groups ◽  
Young Patients ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Lesion Length ◽  
Optimal Cutoff ◽  
Old Patients ◽  
St Elevation

Abstract Background ST-elevation myocardial infarction (STEMI) in young patients has a unique risk profile. We aimed to detect bacteria in aspirate of infarct artery in young versus old patients. Results Aspirates of consecutive 140 patients who underwent a primary coronary intervention were taken for bacteriological, microscopical, and immunohistochemical (for bacterial pneumolysin) examinations. Their results were calculated in young (≤ 50 years) versus old (> 50 years) patients. Median age (interquartile range) was 45 (38–48) years in young (60 patients) and 59 (55–65) years in old (80 patients) patients, p < 0.0001. Both groups had similar baseline data except age, males, diabetes, hyperlipidemia, family history, lesion length, and ectatic vessel. Different bacteria were cultured in 11.3% of all patients involving 22.6% of young and 2.8% of old patients [hazard ratio 8.03 (95% CI 1.83–51.49), p = 0.002]. By multivariate analyses, age groups and leukocytic count were independent predictors of infection (bacteria and pneumolysin), p = 0.027 and p < 0.0001, respectively. Optimal cutoff value of leukocytic count was 12,250 cells/μl [ROC curve sensitivity 85.7%, specificity 86.4%, and AUC 0.97 (95% CI 0.95–1.0), p < 0.001]. Infection was an independent predictor of STEMI in young versus old patients, p < 0.001. Nevertheless, in-hospital events occurred insignificantly different and neither age groups nor infection was predictor of in-hospital events. Conclusions Young patients had significantly higher percentage of bacteria in their infarcted artery than old patients. High leukocytic count in patients below 50 predicts infection that causes acute myocardial infarction. Antibacterial trials directed toward this group are required for secondary prevention.

Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis

2020 ◽  
pp. neurintsurg-2020-015873 ◽  
Author(s):  
Xiao Wu ◽  
Mihir Khunte ◽  
Dheeraj Gandhi ◽  
Charles Matouk ◽  
Danny R Hughes ◽  
...  
Keyword(s):  
Cost Saving ◽  
Age Groups ◽  
Health Benefit ◽  
Cost Savings ◽  
The United States ◽  
Base Case ◽  
Stroke Patients ◽  
Vessel Occlusion ◽  
Old Patients ◽  
Life Years

BackgroundThe benefit of endovascular thrombectomy (EVT) in stroke patients with large-vessel occlusion (LVO) depends on the degree of recanalization achieved. We aimed to determine the health outcomes and cost implications of achieving TICI 2b vs TICI 3 reperfusion in acute stroke patients with LVO.MethodsA decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years (QALY) of EVT-treated patients, and costs based on the degree of reperfusion achieved. The study was performed with a societal perspective in the United States' setting. The base case calculations were performed in three age groups: 55-, 65-, and 75-year-old patients.ResultsWithin 90 days, achieving TICI 3 resulted in a cost saving of $3676 per patient and health benefit of 11 days in perfect health as compared with TICI 2b. In the long term, for the three age groups, achieving TICI 3 resulted in cost savings of $46,498, $25,832, and $15 719 respectively, and health benefits of 2.14 QALYs, 1.71 QALYs, and 1.23 QALYs. Every 1% increase in TICI 3 in 55-year-old patients nationwide resulted in a cost saving of $3.4 million and a health benefit of 156 QALYs. Among 65-year-old patients, the corresponding cost savings and health benefit were $1.9 million and 125 QALYs.ConclusionThere are substantial cost and health implications in achieving complete vs incomplete reperfusion after EVT. Our study provides a framework to assess the cost-benefit analysis of emerging diagnostic and therapeutic techniques that might improve patient selection, and increase the chances of achieving complete reperfusion.

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