OBJECTIVES

: In current care, eligibility for thrombolysis or thrombectomy as acute stroke treatments is based on imaging (CT and CTA), time since onset and patient history. SPCCT is an emerging technology expected to shorten the stroke assessment phase, thereby enabling reperfusion treatment for more ischaemic patients and, in turn, obtaining greater health outcomes. This study investigates the potential cost-effectiveness of SPCCT (versus CT+CTA) in identifying and treating ischaemic stroke patients in the UK.

METHODS

: A decision-analytic model built on a decision tree and a Markov trace was developed. A hypothetical cohort of suspected stroke patients aged 74 was modeled. Costs, outcomes and probabilities were obtained from the literature. Outcomes of the model included costs, life-years, quality-adjusted life-years, and incremental cost-effectiveness ratios. Univariate and probabilistic sensitivity analyses were performed. Scenario analyses enabled to vary the impact of SPCCT in shortening the stroke assessment phase.

RESULTS

: Currently, an estimated 17% of the ischaemic stroke patients receive CT+CTA within 4.5 hours from symptom onset in the UK. Three scenarios were simulated in which SPCCT would increase this proportion by factors of 1.25, 2 and 4. Over the three-month and lifetime horizons, all three scenarios improved QALYs and LYs compared to CT-CTA. Based on the currently used estimates, SPCCT has a probability of dominance above 50% for scenarios 1, 2 and 3, respectively. The probability of cost-effectiveness at a willingness-to-pay threshold of £20000/QALY is nearly 100% in all scenarios.

CONCLUSIONS

: Based on preliminary results, replacing CT-CTA with SPCCT to identify and treat more ischaemic stroke patients may be good value for money. However, additional data regarding clinical outcomes following SPCCT based strategies are needed before the cost-effectiveness can be fully assessed. Other benefits of SPCCT (such as its higher resolution) are expected to help with patient identification or treatment decisions and might be incorporated into future cost-effectiveness assessments.