Abstract WP71: Endovascular Thrombectomy With Or Without Bridging Thrombolysis In Patients With Acute Ischemic Stroke: A Cost-utility Analysis
Bibliographic record
Abstract
Introduction: There is clinical equipoise behind bridging intravenous thrombolysis (BT) with endovascular thrombectomy (EVT). We performed a cost-effectiveness analysis comparing BT versus EVT alone. Methods: We conducted a model-based cost-utility analysis comparing the cost-effectiveness of BT vs EVT only for patients with acute ischemic stroke. We used a decision tree to examine the short-term costs and outcomes at 90 days after the index stroke, and developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. Clinical outcome inputs were derived from our systematic review. We considered the impact of disability and recurrent stroke on mortality risk, health-related quality of life, and costs. We estimated total and incremental cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER). Probabilistic analysis was used to calculate the reference case estimates. Results: The average costs per patient were estimated to be $55,503, $57,814, $68,183, and $84,946 for EVT only strategy, and $47,311, $49,556, $59,625, and $75,898 for BT over 90-day, 1-year, 5-year, and 20-year, respectively. The cost saving of EVT only strategy was driven by the avoided medication costs of IVT (ranging from $8,193 to $9,048). The additional thrombolytics led to slight decrease in QALY estimate during the 90-day time horizon (loss of 0.0016 QALY), but a small gain over 1-year, 5-year, and 20-year time horizons (0.0108, 0.0638, and 0.1481 QALY). With similar outcomes and less cost, the EVT only strategy was cost-effective compared with BT. Analyses with longer time horizon show lower probabilities of EVT only strategy being cost-effective. At a fixed willingness to pay threshold of $50,000, the probabilities of EVT only to be cost-effective were 100%, 100%, 99.0%, and 65.9% over 90-day, 1-year, 5-year, and 20-year time horizons. At the willingness to pay thresholds of $100,000 per QALY, the probabilities of EVT only strategy being cost-effective was 22.8% over the 20-year time horizon. Conclusions: Our cost-effectiveness model suggested that bridging with thrombolytics may not be cost-effective for patients with acute ischemic stroke secondary to large vessel occlusion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.028 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.003 | 0.010 |
| Bibliometrics | 0.005 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".