Cost-effectiveness Analysis of Intracranial Stent Placement Versus Contemporary Medical Management in Patients with Symptomatic Intracranial Artery Stenosis

Overview

Journal J Vasc Interv Neurol

Date 2013 Dec 21

PMID 24358413

Citations 1

Authors

Amir Khan

Ameer Hassan

Fareed Suri

Adnan Qureshi

Affiliations

Soon will be listed here.

Abstract

Background: Intracranial angioplasty and stent placement has been increasingly evaluated as a new method for treatment of symptomatic intracranial stenosis in select patients. The Food and Drug Administration (FDA) has approved intracranial stent treatment of symptomatic atherosclerotic intracranial lesions.

Purpose: To determine the cost-effectiveness of intracranial artery stent placement compared with contemporary medical management for secondary stroke prevention among patients with symptomatic intracranial stenosis.

Methods: Clinical outcome data were obtained from the aspirin treatment arm of the Comparison of Warfarin and Aspirin for Symptomatic Intracranial Disease (WASID) trial (n = 280) and 12 case series (n = 216) of patients who underwent stent placement of symptomatic intracranial stenosis with comparable characteristics. Total cost of procedure and medical management-only was calculated using the rates of major stroke, minor stroke, or death in each group. All costs are expressed in 2010 US$. The quality-adjusted life-year (QALY) of each intervention strategy was estimated using the frequency of the outcomes of major and minor stroke, death, and baseline health. An incremental cost-effectiveness ratio (ICER) was formulated for a 1-year period.

Results: The total rate of stroke at one year was 10.2% (6.1-14.2%) and the rate of all-cause mortality was 3.7% (1.2-6.2%) in the stent group. The corresponding annualized rates of stroke and all-cause mortality in the medical management-only group were 15% (10.8-19.2%) and 2.4% (0.6-4.2%), respectively. The calculated net costs at one year for intracranial stent placement and contemporary medical management were US$16,898 and US$3,468, respectively. Overall, QALYs for the two groups were 0.82 and 0.81 (in a range of 0 to 0.89 corresponding to death and baseline health), respectively. The cost per QALY gained after intracranial stent placement and contemporary medical therapy was US$20,542 and US$4,265, respectively. The corresponding ICER for stent versus medical treatment alone was US$1,416,268.

Conclusion: The reduced risk of stroke following intracranial stent placement is offset by significantly higher procedure-associated net costs. Select procedures in patients with symptomatic stenosis of 70% or greater are more likely to be cost-effective.

Citing Articles

Effect of Risk-Focused Diversified Safety Management Mode in Patients with Major Artery Stent Implantation.

Shao Y, Wu C, Mao Y, Li D, Wang Y, Zhu K Emerg Med Int. 2022; 2022:1284254.

PMID: 36212997 PMC: 9546671. DOI: 10.1155/2022/1284254.

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