Economic evaluation of stent retrievers in basilar artery occlusion: An analysis from Chinese healthcare system perspective

• Published in: PloS one 2023-11, Vol.18 (11), p.e0294929-e0294929
• Main Authors: Xia, Hailong, Yang, Qi, Wang, Qibo, Jia, Jielin, Liu, Xipeng, Meng, Shu
• Format: Article
• Language: English
• Subjects: Analysis; Biology and Life Sciences; Care and treatment; Complications and side effects; Diagnosis; Economic aspects; Evaluation; Markov processes; Medical care, Cost of; Medicine and Health Sciences; Patient outcomes; People and Places; Physical Sciences; Social Sciences; Stent (Surgery); Stroke (Disease)
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0294929

This study aimed to investigate the cost-effectiveness of stent retriever (SR) versus best medical management (BMM) in patients with basilar artery occlusion (BAO) in China. We used a two-step approach to compare the cost-effectiveness of SR plus BMM with that of BMM alone over 20 years. A decision tree was initially constructed for the first 3 months, followed by a Markov model for the subsequent period. Collected data on clinical aspects were extracted from the BAOCHE investigation, while costs-related information was sourced from previously published research. The key metric for evaluating the primary outcome was the incremental cost-effectiveness ratio (ICER), achieved $/QALY. The threshold for identifying SR as highly cost-effective was set at an ICER below $12,551/QALY, SR was deemed cost-effective if the ICER ranged from $12,551 to $37,654 per QALY. Uncertainty was addressed using scenario, one-way sensitivity, and probabilistic sensitivity analyses (PSA). For Chinese patients with BAO, the 20-year cost per patient was $8678 with BMM alone and $21,988 for SR plus BMM. Effectiveness was 1.45 QALY for BMM alone, and 2.77 QALY for SR plus BMM. The ICER of SR + BMM versus BMM alone was $10,050 per QALY. The scenario and one-way sensitivity analyses revealed that in certain situations the ICER could exceed $12,551 per QALY, but remain below $37,654 per QALY. Results from the PSA suggested that SR was likely to be cost-effective for Chinese patients with BAO, with a probability exceeding 98% when considering a willingness-to-pay (WTP) threshold of $12,551 per QALY. Our study indicates that SR is an intervention option that is highly likely to be cost-effective for Chinese patients with BAO, with a probability of over 98% under the current WTP threshold of $12,551 per QALY.