Is mechanical clot removal or disruption a cost-effective treatment for XXXX ?

@entity1 @entity64 @entity432 @entity385
BACKGROUND AND PURPOSE: It is unclear whether the costs and risks of mechanical therapies make them cost-effective. We examined whether interventions such as mechanical clot removal or disruption with angioplasty are cost-effective for acute @entity385 compared with best medical therapy. MATERIALS AND METHODS: We performed a cost-utility analysis of @entity1 with @entity64 due to large intracranial @entity432 presenting beyond the 3-hour window for IV tPA. Model inputs for the mechanical arm were derived from Multi MERCI trial data and a recent meta-analysis. For best medical therapy, we used rates of spontaneous recanalization, ICH, and functional outcomes based on a systematic literature review. Discounted QALYs were determined by using the Markov modeling for 65-year-old @entity1 with acute @entity385 . RESULTS: On the basis of a systematic literature review, we modeled an 84% rate of recanalization with mechanical intervention and a 6.3% rate of symptomatic ICH. For best medical therapy, we modeled a spontaneous recanalization rate of 24% with a 2% rate of symptomatic ICH. Mechanical therapies were associated with a  7718 net cost and a gain of a 0.82 QALYs for each use, thus yielding a net of  9386/QALY gained. In sensitivity analyses, results were dependent on the rates of recanalization, symptomatic ICH rates, and costs of treatment. CONCLUSIONS: On the basis of available data, mechanical therapies in qualified @entity1 with @entity64 beyond the window for IV tPA appear to be cost-effective. However, the inputs are not derived from randomized trials, and results are sensitive to several assumptions.
