New Paper Quantifying the Health and Cost Effects of Faster EVT

Currently 20% of LVOs are initially undetected and 40% of patients are treated too late.

The main conclusion from this paper is that EVT administered 1 minute faster results in overall healthcare cost savings on average of €309 and 1.3 days of disability free life in the Netherlands. Those numbers for an hour faster treatment translate to €18, 540 euro and 80 days on average.

Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands

Henk van Voorst, Wolfgang G Kunz, Lucie A van den Berg, Manon Kappelhof, Floor M E Pinckaers, Mayank Goyal, Myriam G M Hunink, Bart Emmer, Maxim Johan Heymen Laurence Mulder, Diederik W J Dippel, J M Coutinho, Henk A Marquering, Hieronymus D Boogaarts, Aad van der Lugt, Wim H van Zwam, Yvo B W E M Roos, Erik Buskens, Marcel G W Dijkgraaf, Charles B L M Majoie, on behalf of the MR CLEAN Registry investigators

Background: The effectiveness of endovascular treatment (EVT) for large vessel occlusion (LVO) stroke severely depends on time to treatment. However, it remains unclear what the value of faster treatment is in the years after index stroke. The aim of this study was to quantify the value of faster EVT in terms of health and healthcare costs for the Dutch LVO stroke population.

Methods: A Markov model was used to simulate 5-year follow-up functional outcome, measured with the modified Rankin Scale (mRS), of 69-year-old LVO patients. Post-treatment mRS was extracted from the MR CLEAN Registry (n=2892): costs per unit of time and Quality-Adjusted Life Years (QALYs) per mRS subscore were retrieved from follow-up data of the MR CLEAN trial (n=500). Net Monetary Benefit (NMB) at a willingness to pay of €80 000 per QALY was reported as primary outcome, and secondary outcome measures were days of disability-free life gained and costs.

Results: EVT administered 1 min faster resulted in a median NMB of €309 (IQR: 226;389), 1.3 days of additional disability-free life (IQR: 1.0;1.6), while cumulative costs remained largely unchanged (median: -€15, IQR: −65;33) over a 5-year follow-up period. As costs over the follow-up period remained stable while QALYs decreased with longer time to treatment, which this results in a near-linear decrease of NMB. Since patients with faster EVT lived longer, they incurred more healthcare costs. Conclusion One-minute faster EVT increases QALYs while cumulative costs remain largely unaffected. Therefore, faster EVT provides better value of care at no extra healthcare costs.

Read the full paper here:

van Voorst H, Kunz WG, van den Berg LA, et al. Quantified health and cost effects of faster endovascular treatment for large vessel ischemic stroke patients in the Netherlands [published online ahead of print, 2021 Jan 21]. J Neurointerv Surg. 2021;neurintsurg-2020-017017. doi:10.1136/neurintsurg-2020-017017

At NICO.LAB we are working hard to ensure we help hospitals to reduce this % and streamline the workflow to reduce door to groin puncture time. It is extremely rewarding to read a paper with powerful numbers that actually quantifies the impact it has on a patient when just one minute is saved.

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