O28/275 Cost utility analysis of bridging intravenous thrombolysis with endovascular thrombectomy
Bibliographic record
Abstract
<h3>Introduction</h3> Clinical equipoise exists behind bridging intravenous thrombolysis (BT) with endovascular thrombectomy (EVT). <h3>Aim of Study</h3> To compare the cost-effectiveness of EVT alone vs. BT in acute ischemic stroke (AIS) <h3>Methods</h3> We conducted a model-based cost-utility analysis comparing the cost-effectiveness of EVT alone vs. BT in AIS. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. 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), expressed as an incremental cost per QALY gained of BT compared with EVT alone. Probabilistic analysis was used to calculate the reference case estimates. <h3>Results</h3> The average costs per patient were estimated to be $55,503, $57,814, $68,183, and $84,946 for BT, and $47,311, $49,556, $59,625, and $75,898 for EVT only 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. <h3>Conclusion</h3> Our cost-effectiveness model suggests bridging with thrombolytics may not be cost-effective in AIS secondary to large vessel occlusion. <h3>Disclosure of Interest</h3> The authors have nothing to disclose.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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 teacher head, 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".