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Efficacy and Efficiency of Mechanical Thromboextraction in Combination with Thrombolytic Therapy or as an Independent Method of Intravascular Treatment in Patients with Ischemic Stroke

Issue № 32 | 2018 (2)

DOI: https://doi.org/10.31556/2219-0678.2018.32.2.048-059 meta

Abstract

The use of highly effective methods of restoring blood fl ow (reperfusion) in ischemic stroke (IS) is still limited. In general, the frequency of thrombolytic therapy (TLT) in the Russian Federation does not reach the minimum recommended target level (5%) – mainly because of late delivery of patients to medical organizations, i.e., when the TLT is no longer indicated. Mechanical thromboextraction (MTE), which can be performed for a longer period after the onset of the disease, improves the outcome of IS, but its use is limited by a high cost.

Study objective: to evaluate the efficacy and efficiency of the use of MTE in patients with IS from the Russian healthcare system perspective.

Methods. The economic burden of IS was modelled for different patient management options. The target population of IS patients consisted of two subgroups: 1) those delivered to the hospital in the first 4.5 hours after the development of IS (candidates for TLT or TLT + MTE), 2) delivered in the first 6 hours after the development of IS, when TLT is not indicated already (candidates for isolated MTE). The economic burden of IS was calculated for the different scenarios of treatment in the acute phase of stroke: the absence of reperfusion (scenario 1.1), TLT (scenario 1.2) or TLT + MTE (scenario 1.3) for the subgroup 1; the absence of reperfusion (scenario 2.1) or MTE as an independent reperfusion method (scenario 2.2) for subgroup 2. The incidence of three possible IS outcomes (functional independence, disability or death) was modelled, based on the meta-analysis of Campbell B.C. et al., 2016. Direct medical, direct non-medical and indirect costs, due to IS and its consequences, were calculated for each of the scenarios. The time horizon was 4 years.

Results. The use of MTE + TLT or MTE only leads to a reduction of direct non-medical costs due to the decrease of social payments for IS-caused disability, and to the reduction of indirect costs caused by GDP losses due to temporary disability, permanent disability and mortality of the economically active population after IS. As a result, the use of MTE + TLT or MTE only reduces the overall economic burden of IS beginning from the 2nd year after IS. The investments into MTE are compensated by the reduction of direct non-medical and indirect costs on the 4th year.

The conclusion. The MTE in combination with TLT or as an independent reperfusion method in the acute period of IS is an effective and efficient
method.

Keywords

ischemic stroke, mechanical thromboextraction, economic analysis.

For citations

Dombrovsky V. S., Ivakhnenko O. I., Avksentyeva M. V., Omelyanovskiy V. V., Musina N. Z. Efficacy and Efficiency of Mechanical Thromboextraction in Combination with Thrombolytic Therapy or as an Independent Method of Intravascular Treatment in Patients with Ischemic Stroke. Medical technologies. Evaluation and selection. 2018; 2 (32): 48–59.

mt_32_2018-2_48-59