| Title: | Analyzing Cost-Effectiveness of Allocating Neurointerventionist for Drive and Retrieve System for Patients with Acute Ischemic Stroke |
| Authors: | Morii, Yasuhiro Browse this author →KAKEN DB |
| Osanai, Toshiya Browse this author |
| Fujiwara, Kensuke Browse this author |
| Tanikawa, Takumi Browse this author →KAKEN DB |
| Houkin, Kiyohiro Browse this author →KAKEN DB |
| Gu, Songzi Browse this author |
| Ogasawara, Katsuhiko Browse this author →KAKEN DB |
| Keywords: | Cost-effectiveness Analysis |
| Geographic Information System |
| Drive and Retrieve System |
| Endovascular Thrombectomy |
| Ischemic Stroke |
| Issue Date: | 15-May-2021 |
| Publisher: | Elsevier |
| Journal Title: | Journal of stroke and cerebrovascular diseases |
| Volume: | 30 |
| Issue: | 8 |
| Start Page: | 105843 |
| Publisher DOI: | 10.1016/j.jstrokecerebrovasdis.2021.105843 |
| PMID: | 34000607 |
| Abstract: | Objectives: There are regional disparities in implementation rates of endovascular thrombectomy due to time and resource constraints such as endovascular thrombec-tomy specialists. In Hokkaido, Japan, Drive and Retrieve System (DRS), where endo-vascular thrombectomy specialists perform early endovascular thrombectomies by traveling from the facilities where they normally work to facilities closer to the patient. This study analyzed the cost-effectiveness of allocating a endovascular thrombectomy specialist for DRS to treat stroke patients. Materials and methods: he number of ischemic stroke patients expected to receive endovascular thrombectomy in Hokkaido in 2015 was estimated. It was assumed that an additional neutointerventionist was allocated for DRS. The analysis was performed from the government's perspective, which includes medical and nursing-care costs, and the personnel cost for endovascular thrombectomy specialist. The analysis was conducted comparing the current scenario, where patients received endovascular thrombectomy in facilities where endovascular thrombectomy specialists normally work, with the scenario with DRS within 60 min drive distance. Patient transport time was analyzed using geographic information system, and patient severity was estimated from the transport time. The primary outcome was incremental cost-effectiveness ratio (ICER) in each medical area which was calculated from the incre-mental costs and the incremental quality-adjusted life years (QALYs), estimated from patient severity using published literature. The entire process was repeated 100 times. Results: DRS was most cost-effective in Kamikawachubu area, where the ICER was $14,173</n>16,802/QALY, significantly lower than the threshold that the Japanese guide-line suggested. Conclusions: Since DRS was cost-effective in Kamikawachubu area, the area should be prioritized when a endovascular thrombectomy specialist for DRS is allo-cated as a policy. |
| Rights: | © 2021. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| https://creativecommons.org/licenses/by-nc-nd/4.0/ |
| Type: | article (author version) |
| URI: | http://hdl.handle.net/2115/86422 |
| Appears in Collections: | 保健科学院・保健科学研究院 (Graduate School of Health Sciences / Faculty of Health Sciences) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
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