ost-effectiveness of Thrombolysis Treatment of Ischemic Stroke Based on Outcomes of CT Perfusion: A Comparative Economics Study_Chinese Journal of Evidence-Based Medicine

Authors：

 SHENJian-tong ¹ , LIXiang-lian ¹ ,  LIYou-ping ¹ , SONGBin ² , WUBing ² , YUANFang ²

1. Chinese Evidence-Based Medicine Center, Sichuan University, Chengdu 610041, China;
2. Radiology Department, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding?author：

LIYou-ping, Email: yzmylab@hotmail.com

Keywords：

CT perfusion; Stroke; Cost-effectiveness analysis

DOI：

10.7507/1672-2531.20140094

Video：

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Objective To evaluate the comparative cost-effectiveness of thrombolysis treatment of ischemic stroke based on outcomes of CT perfusion (CTP). Methods We applied the methods of systematic review to evaluate the studies abroad about the cost effectiveness of CTP diagnosis outcomes used for selecting stroke patients for thrombolysis treatment. We also evaluated the domestic studies about the cost-effectiveness of CTP in China by establishing a decision tree model. Results A total of 2 economics studies were included. The results showed that, the cost-effectiveness ratios of CT, CTP and MRI for selecting stroke patients for thrombolysis treatment were 2 983.7 ￡/QALY, 2 951.4 ￡/QALY and 2 982.9 ￡/ QALY, respectively, in the UK; 100 483.5＄/QALY and 99 406.1＄/QALY just for CT and CTP, respectively, in the US; and the evaluation outcomes by establishing the decision tree model showed that, 113 492.4 ￥/QALY, 113 615￥/QALY and 120 831.9 ￥/QALY, respectively, in China. Conclusion All international and domestic studies' results show that CTP is more cost-effective than CT/MRI in selecting stroke patients for thrombolysis treatment.

Citation： SHENJian-tong, LIXiang-lian, LIYou-ping, SONGBin, WUBing, YUANFang. ost-effectiveness of Thrombolysis Treatment of Ischemic Stroke Based on Outcomes of CT Perfusion: A Comparative Economics Study. Chinese Journal of Evidence-Based Medicine, 2014, 14(5): 554-560. doi: 10.7507/1672-2531.20140094 Copy

1.	Murray CJ, Vos T, Lozano R, et al. Global and regional burden of stroke during 1990-2010:findings from the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2197-2223.
2.	Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990-2010:findings from the Global Burden of Disease Study 2010. Lancet, 2013, 381(9882):1987-2015.
3.	Liao XL, Wang CX, Wang YL, et al. Implementation and outcome of thrombolysis with alteplase 3 to 4.5 h after acute stroke in Chinese patients. CNS Neurosci Ther, 2013, 19(1):43-47.
4.	Turk A, Magarik JA, Chaudry I, et al. CT perfusion-guided patient selection for endovascular treatment of acute ischemic stroke is safe and effective. J Neurointerv Surg, 2012, 4(4):261-265.
5.	Sztriha LK, Manawadu D, Jarosz J, et al. Safety and clinical outcome of thrombolysis in ischaemic stroke using a perfusion CT mismatch between 3 and 6 hours. PLoS One, 2011, 6(10):e25796.
6.	García-Bermejo P, Calleja AI, Pérez-Fernández S, et al. Perfusion computed tomography-guided intravenous thrombolysis for acute ischemic stroke beyond 4.5 hours:a case-control study. Cerebrovasc Dis, 2012, 34(1):31-37.
7.	中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組.中國急性缺血性腦卒中診治指南2010.中國全科醫學, 2011, 14(12B):4013-4017.
8.	Earnshaw SR, McDade C, Chapman AM, et al. Economic impact of using additional diagnostic tests to better select patients with stroke for intravenous thrombolysis in the United Kingdom. Clin Ther, 2012, 34(7):1544-1558.
9.	Jackson D, Earnshaw SR, Farkouh R, et al. Cost-effectiveness of CT perfusion for selecting patients for intravenous thrombolysis:a US hospital perspective. AJNR Am J Neuroradiol, 2010, 31(9):1669-1674.
10.	Liao XL, Wang CX, Wang YL, et al. Implementation and Outcome of Thrombolysis with Alteplase 3 to 4.5h After Acute Stroke in Chinese Patients. CNS Neuroscience & Therapeutics, 2013, 19(1):43-47.
11.	Chen C, Ye M, Chen BL, et al. Thrombolysis on ischemic stroke patients with decreased level of consciousness within 4.5 h. CNS Neuroscience & Therapeutics, 2013, 19(1):48-52.
12.	Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment:pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet, 2004, 363(9411):768-774.
13.	Schellinger PD, Thomalla G, Fiehler J, et al. MRI-based and CTbased thrombolytic therapy in acute stroke within and beyond established time windows:an analysis of 1210 patients. Stroke, 2007, 38(10):2640-2645.
14.	Wei JW, Arima H, Huang Y, et al. Variation in the Frequency of Intracerebral Haemorrhage and Ischaemic Stroke in China:A National, Multicentre, Hospital Register Study. Cerebrovasc Dis Extra, 2010, 29(4):321-327.
15.	Wei JW, Huang Y, Wang JG, et al. Current management of intracerebral haemorrhage in China:a national, multi-centre, hospital register study. BMC Neurol, 2011, 11:16.
16.	Cohnen M, Wittsack HJ, Assadi S, et al. Radiation exposure of patients in comprehensive computed tomography of the head in acute stroke. AJNR Am J Neuroradiol, 2006, 27(8):1741-1745.
17.	Diekmann S, Siebert E, Juran R, et al. Dose exposure of patients undergoing comprehensive stroke imaging by multidetector-row CT: comparison of 320-detector row and 64-detector row CT scanners. AJNR Am J Neuroradiol, 2010, 31(6):1003-1009.
18.	Yamauchi-Kawara C, Fujii K, Aoyama T, et al. Radiation dose evaluation in multidetector-row CT imaging for acute stroke with an anthropomorphic phantom. Br J Radiol, 2010, 83(996):1029-1041.
19.	Mnyusiwalla A, Aviv RI, Symons SP. Radiation dose from multidetector row CT imaging for acute stroke. Neuroradiology, 2009, 51(10):635-640.
20.	Hoeffner EG, Case I, Jain R, et al. Cerebral Perfusion CT:Technique and Clinical Applications. Radiology, 2004, 231(3):632-644.
21.	暴婧, 吳巍珍, 杜湘柯, 等.計算機體層攝影檢查中對比劑腎病的流行病學研究.中國血液凈化, 2011, 10(8):416-420.
22.	Darby DG, Barber PA, Gerraty RP, et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke, 1999, 30(10):2043-2052.
23.	Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra:receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke, 2006, 37(4):979-985.
24.	張茁, 張微微, 畢齊, 等. 2270例卒中患者延誤診治時間的因素分析.中國腦血管病雜志, 2005, 2(2):62-64.
25.	王伊龍, 吳敵, 周永, 等.中國七城市卒中患者急診溶栓情況分析.中國卒中雜志, 2009, 4(1):23-28.
26.	Wei JW, Heeley EL, Jan S, et al. Variations and determinants of hospital costs for acute stroke in China. PLoS One, 2010, 5(9):e13041.
27.	劉國恩, 劉國恩, 張玉哲, 等.急性缺血性腦卒中三種常用神經保護藥物成本-效果分析.中國衛生經濟, 2012, 31(8):62-65.
28.	張興文.缺血性腦卒中直接醫療成本及其與預后關系研究.北京:中國協和醫科大學, 2008.
29.	Samsa GP, Reutter RA, Parmigiani G, et al. Performing costeffectiveness analysis by integrating randomized trial data with a comprehensive decision model:application to treatment of acute ischemic stroke. J Clin Epidemiol, 1999, 52(3):259-271.
30.	Liao XL, Wang CX, Wang YL, et al. Implementation and outcome of thrombolysis with alteplase 3 to 4.5 h after acute stroke in Chinese patients. CNS Neurosci Ther, 2013, 19(1):43-47.
31.	Nagakane Y, Christensen S, Brekenfeld C, et al. EPITHET:Positive result after reanalysis using baseline diffusion-weighted imaging/ perfusion-weighted imaging co-registration. Stroke, 2011, 42(1):59-64.

1. Murray CJ, Vos T, Lozano R, et al. Global and regional burden of stroke during 1990-2010:findings from the Global Burden of Disease Study 2010. Lancet, 2012, 380(9859):2197-2223.
2. Yang G, Wang Y, Zeng Y, et al. Rapid health transition in China, 1990-2010:findings from the Global Burden of Disease Study 2010. Lancet, 2013, 381(9882):1987-2015.
3. Liao XL, Wang CX, Wang YL, et al. Implementation and outcome of thrombolysis with alteplase 3 to 4.5 h after acute stroke in Chinese patients. CNS Neurosci Ther, 2013, 19(1):43-47.
4. Turk A, Magarik JA, Chaudry I, et al. CT perfusion-guided patient selection for endovascular treatment of acute ischemic stroke is safe and effective. J Neurointerv Surg, 2012, 4(4):261-265.
5. Sztriha LK, Manawadu D, Jarosz J, et al. Safety and clinical outcome of thrombolysis in ischaemic stroke using a perfusion CT mismatch between 3 and 6 hours. PLoS One, 2011, 6(10):e25796.
6. García-Bermejo P, Calleja AI, Pérez-Fernández S, et al. Perfusion computed tomography-guided intravenous thrombolysis for acute ischemic stroke beyond 4.5 hours:a case-control study. Cerebrovasc Dis, 2012, 34(1):31-37.
7. 中華醫學會神經病學分會腦血管病學組急性缺血性腦卒中診治指南撰寫組.中國急性缺血性腦卒中診治指南2010.中國全科醫學, 2011, 14(12B):4013-4017.
8. Earnshaw SR, McDade C, Chapman AM, et al. Economic impact of using additional diagnostic tests to better select patients with stroke for intravenous thrombolysis in the United Kingdom. Clin Ther, 2012, 34(7):1544-1558.
9. Jackson D, Earnshaw SR, Farkouh R, et al. Cost-effectiveness of CT perfusion for selecting patients for intravenous thrombolysis:a US hospital perspective. AJNR Am J Neuroradiol, 2010, 31(9):1669-1674.
10. Liao XL, Wang CX, Wang YL, et al. Implementation and Outcome of Thrombolysis with Alteplase 3 to 4.5h After Acute Stroke in Chinese Patients. CNS Neuroscience & Therapeutics, 2013, 19(1):43-47.
11. Chen C, Ye M, Chen BL, et al. Thrombolysis on ischemic stroke patients with decreased level of consciousness within 4.5 h. CNS Neuroscience & Therapeutics, 2013, 19(1):48-52.
12. Hacke W, Donnan G, Fieschi C, et al. Association of outcome with early stroke treatment:pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials. Lancet, 2004, 363(9411):768-774.
13. Schellinger PD, Thomalla G, Fiehler J, et al. MRI-based and CTbased thrombolytic therapy in acute stroke within and beyond established time windows:an analysis of 1210 patients. Stroke, 2007, 38(10):2640-2645.
14. Wei JW, Arima H, Huang Y, et al. Variation in the Frequency of Intracerebral Haemorrhage and Ischaemic Stroke in China:A National, Multicentre, Hospital Register Study. Cerebrovasc Dis Extra, 2010, 29(4):321-327.
15. Wei JW, Huang Y, Wang JG, et al. Current management of intracerebral haemorrhage in China:a national, multi-centre, hospital register study. BMC Neurol, 2011, 11:16.
16. Cohnen M, Wittsack HJ, Assadi S, et al. Radiation exposure of patients in comprehensive computed tomography of the head in acute stroke. AJNR Am J Neuroradiol, 2006, 27(8):1741-1745.
17. Diekmann S, Siebert E, Juran R, et al. Dose exposure of patients undergoing comprehensive stroke imaging by multidetector-row CT: comparison of 320-detector row and 64-detector row CT scanners. AJNR Am J Neuroradiol, 2010, 31(6):1003-1009.
18. Yamauchi-Kawara C, Fujii K, Aoyama T, et al. Radiation dose evaluation in multidetector-row CT imaging for acute stroke with an anthropomorphic phantom. Br J Radiol, 2010, 83(996):1029-1041.
19. Mnyusiwalla A, Aviv RI, Symons SP. Radiation dose from multidetector row CT imaging for acute stroke. Neuroradiology, 2009, 51(10):635-640.
20. Hoeffner EG, Case I, Jain R, et al. Cerebral Perfusion CT:Technique and Clinical Applications. Radiology, 2004, 231(3):632-644.
21. 暴婧, 吳巍珍, 杜湘柯, 等.計算機體層攝影檢查中對比劑腎病的流行病學研究.中國血液凈化, 2011, 10(8):416-420.
22. Darby DG, Barber PA, Gerraty RP, et al. Pathophysiological topography of acute ischemia by combined diffusion-weighted and perfusion MRI. Stroke, 1999, 30(10):2043-2052.
23. Wintermark M, Flanders AE, Velthuis B, et al. Perfusion-CT assessment of infarct core and penumbra:receiver operating characteristic curve analysis in 130 patients suspected of acute hemispheric stroke. Stroke, 2006, 37(4):979-985.
24. 張茁, 張微微, 畢齊, 等. 2270例卒中患者延誤診治時間的因素分析.中國腦血管病雜志, 2005, 2(2):62-64.
25. 王伊龍, 吳敵, 周永, 等.中國七城市卒中患者急診溶栓情況分析.中國卒中雜志, 2009, 4(1):23-28.
26. Wei JW, Heeley EL, Jan S, et al. Variations and determinants of hospital costs for acute stroke in China. PLoS One, 2010, 5(9):e13041.
27. 劉國恩, 劉國恩, 張玉哲, 等.急性缺血性腦卒中三種常用神經保護藥物成本-效果分析.中國衛生經濟, 2012, 31(8):62-65.
28. 張興文.缺血性腦卒中直接醫療成本及其與預后關系研究.北京:中國協和醫科大學, 2008.
29. Samsa GP, Reutter RA, Parmigiani G, et al. Performing costeffectiveness analysis by integrating randomized trial data with a comprehensive decision model:application to treatment of acute ischemic stroke. J Clin Epidemiol, 1999, 52(3):259-271.
30. Liao XL, Wang CX, Wang YL, et al. Implementation and outcome of thrombolysis with alteplase 3 to 4.5 h after acute stroke in Chinese patients. CNS Neurosci Ther, 2013, 19(1):43-47.
31. Nagakane Y, Christensen S, Brekenfeld C, et al. EPITHET:Positive result after reanalysis using baseline diffusion-weighted imaging/ perfusion-weighted imaging co-registration. Stroke, 2011, 42(1):59-64.

Chinese Journal of Evidence-Based Medicine

ost-effectiveness of Thrombolysis Treatment of Ischemic Stroke Based on Outcomes of CT Perfusion: A Comparative Economics Study

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