Neuroepidemiology最新文献

{"title":"Cost-Effectiveness of an Individualised Management Program after Stroke: A Trial-Based Economic Evaluation.","authors":"Zhomart Orman, Muideen T Olaiya, Amanda G Thrift, Dominique A Cadilhac, Thanh Phan, Mark R Nelson, David Ung, Velandai K Srikanth, Christopher F Bladin, Richard P Gerraty, Joseph Phillipos, Joosup Kim","doi":"10.1159/000535638","DOIUrl":"10.1159/000535638","url":null,"abstract":"<p><strong>Introduction: </strong>Evidence on the cost-effectiveness of comprehensive post-stroke programs is limited. We assessed the cost-effectiveness of an individualised management program (IMP) for stroke or transient ischaemic attack (TIA).</p><p><strong>Methods: </strong>A cost-utility analysis alongside a randomised controlled trial with a 24-month follow-up, from both societal and health system perspectives, was conducted. Adults with stroke/TIA discharged from hospitals were randomised by primary care practice to receive either usual care (UC) or an IMP in addition to UC (intervention). An IMP included stroke-specific nurse-led education and a specialist review of care plans at baseline, 3 months, and 12 months, and telephone reviews by nurses at 6 months and 18 months. Costs were expressed in 2021 Australian dollars (AUD). Costs and quality-adjusted life years (QALYs) beyond 12 months were discounted by 5%. The probability of cost-effectiveness of the intervention was determined by quantifying 10,000 bootstrapped iterations of incremental costs and QALYs below the threshold of AUD 50,000/QALY.</p><p><strong>Results: </strong>Among the 502 participants (65% male, median age 69 years), 251 (50%) were in the intervention group. From a health system perspective, the incremental cost per QALY gained was AUD 53,175 in the intervention compared to the UC group, and the intervention was cost-effective in 46.7% of iterations. From a societal perspective, the intervention was dominant in 52.7% of iterations, with mean per-person costs of AUD 49,045 and 1.352 QALYs compared to mean per-person costs of AUD 51,394 and 1.324 QALYs in the UC group. The probability of the cost-effectiveness of the intervention, from a societal perspective, was 60.5%.</p><p><strong>Conclusions: </strong>Care for people with stroke/TIA using an IMP was cost-effective from a societal perspective over 24 months. Economic evaluations of prevention programs need sufficient time horizons and consideration of costs beyond direct healthcare utilisation to demonstrate their value to society.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"156-165"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11152005/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139742712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Age and Sex Disparities in Cardiovascular Risk Factor Management prior to Stroke: Linked Registry and General Practice Data.","authors":"Kiran Bam, Monique F Kilkenny, Joosup Kim, Dominique A Cadilhac, Christopher Pearce, Nadine E Andrew, Lauren Sanders, Amanda G Thrift, Mark R Nelson, Seana Gall, Galina Daraganova, Muideen T Olaiya","doi":"10.1159/000538067","DOIUrl":"10.1159/000538067","url":null,"abstract":"<p><strong>Introduction: </strong>There is limited evidence about the management of cardiovascular risk factors within 12 months before stroke or transient ischaemic attack (TIA) in Australian general practices. We evaluated whether age and sex disparities in cardiovascular risk factor management for primary prevention exist in general practice.</p><p><strong>Methods: </strong>A retrospective cohort study using data from the Australian Stroke Clinical Registry (2014-2018) linked with general practice data from three Primary Health Networks in Victoria, Australia. We included adults who had ≥2 encounters with a general practitioner within 12 months immediately before the first stroke/TIA. Cardiovascular risk factor management within 12 months before stroke/TIA was evaluated in terms of: assessment of risk factors (blood pressure [BP], serum lipids, blood glucose, body weight); prescription of prevention medications (BP-lowering, lipid-lowering, glucose-lowering, antithrombotic agents); and attainment of risk factor targets.</p><p><strong>Results: </strong>Of 2,880 patients included (median age 76.5 years, 48.4% women), 80.9% were assessed for BP, 49.9% serum lipids, 46.8% blood glucose, and 39.3% body weight. Compared to patients aged 65-84 years, those aged &lt;65 or ≥85 years were less often assessed for risk factors, with women aged ≥85 years assessed for significantly fewer risk factors than their male counterparts. The most prescribed prevention medications were BP-lowering (64.9%) and lipid-lowering agents (42.0%). There were significant sex differences among those aged &lt;65 years (34.7% women vs. 40.2% men) and ≥85 years (34.0% women vs. 44.3% men) for lipid-lowering agents. Risk factor target attainment was generally poorer in men than women, especially among those aged &lt;65 years.</p><p><strong>Conclusion: </strong>Age-sex disparity exists in risk factor management for primary prevention in general practice, and this was more pronounced among younger patients and older women.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"342-350"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementia Screening in Rural Kenya: The Prevalence and Impact of Screening Positive for Dementia.","authors":"Christine W Musyimi, David M Ndetei, Levi A Muyela, Joe Masila, Nicolas Farina","doi":"10.1159/000536012","DOIUrl":"10.1159/000536012","url":null,"abstract":"<p><strong>Introduction: </strong>In Kenya, there is a lack of data on the number of people with dementia. In this article, we aim to estimate the number of community-dwelling older adults (aged 60 years and above) that are potentially living with dementia in rural Kenya.</p><p><strong>Methods: </strong>Recruitment of older adults occurred through adopting a convenience approach based on the catchment areas served by ten trained community health workers. Screening was conducted using the Brief Community Screening Instrument for Dementia (CSI-D), in which prevalence ratios were reported. Regression analyses were run to understand the association between screening outcome and wellbeing, social isolation, and employment status (adjusted for age, sex, literacy, geography, and social status).</p><p><strong>Results: </strong>Of the 3,546 older adults who were screened for dementia, 652 screened positive (PR = 0.18, 95% CIs: 0.17-0.20). Back estimating screen positives based on established sensitivity and specificity of the tool against a gold standard (clinical diagnosis), yielded a prevalence of 9.4% (0.09, 95% CIs: 0.08-0.11). Screening positive for dementia was associated with poorer quality of life (B = -0.17, p &lt; 0.001) and loneliness (B = 0.28, p &lt; 0.001).</p><p><strong>Conclusion: </strong>There are potentially 258,000 older adults living with dementia in Kenya, who likely have poorer outcomes. We need to encourage a timely diagnosis and develop better ways to support people living with dementia in Kenya and other resource-limited settings.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"174-181"},"PeriodicalIF":5.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11151958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140121420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current and Future Cost Burden of Ischemic Stroke in Australia: Dynamic Model.","authors":"Tamrat Befekadu Abebe, Jenni Ilomaki, Adam Livori, J Simon Bell, Jedidiah I Morton, Zanfina Ademi","doi":"10.1159/000538564","DOIUrl":"10.1159/000538564","url":null,"abstract":"<p><strong>Background: </strong>Stroke remains one of the leading causes of morbidity and mortality in Australia. The objective of this study was to estimate the current and future cost burden of ischemic stroke (IS) in Australia.</p><p><strong>Method: </strong>First, the annual chronic management cost per person following IS were derived for all people aged ≥30 years discharged from a public or private hospital in Victoria, Australia between July 2012 and June 2017 (with follow-up data until June 2018 [n = 34,471]). Then extrapolated the data from from Victoria to the whole Australian population aged between 30 years and 99 years to project the total healthcare costs following IS (combination of acute event and chronic management cost) over a 20-year period (2019-2038) using a dynamic multistate life table model. Data for the dynamic model were sourced from the Victorian Admitted Episodes Dataset (VAED) and supplemented with other published data.</p><p><strong>Result: </strong>The estimated annual total chronic management cost following IS was 13,525 Australian dollars (AUD) per person (95% CI: AUD 13,380, AUD 13,670) for cohorts in the VAED between July 2012 and June 2017. The annual chronic management cost was estimated to decline following IS. The highest cost was incurred in the first year of follow-up post-IS (AUD 14,309 per person) and declined to AUD 9,776 in the sixth year of follow-up post-IS. The total healthcare cost for people aged 30-99 years was projected to be AUD 47.7 billion (95% UI: AUD 44.6 billion, AUD 51.0 billion) over the 20-year period (2019-2038) Australia-wide, of which 91.3% (AUD 43.6 billion) was attributed to chronic management costs and the remaining 8.7% (AUD 4.2 billion) were due to acute IS events.</p><p><strong>Conclusion: </strong>IS has and will continue to have a considerable financial impact in the next 2 decades on the Australian healthcare system. Our estimated and projected cost burden following IS provides important information for decision making in relation to IS.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"358-368"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11449186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140337751","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of SARS-CoV-2 Incidence and Immunisation Rates on Sporadic Creutzfeldt-Jakob Disease Incidence.","authors":"Peter Hermann, Julia Böhnke, Timothy Bunck, Stefan Goebel, Veronika K Jaeger, André Karch, Inga Zerr","doi":"10.1159/000535112","DOIUrl":"10.1159/000535112","url":null,"abstract":"<p><strong>Background: </strong>Recent case studies and media outlets have hypothesised an effect of SARS-CoV-2 infection and immunisation on the development or progression of neurodegenerative diseases such as Alzheimer's disease or sporadic Creutzfeldt-Jakob disease (sCJD).</p><p><strong>Objectives: </strong>This study aims to identify potential associations of SARS-CoV-2 infections and SARS-CoV-2 immunisation with sCJD incidence, disease duration, and age of onset.</p><p><strong>Method: </strong>We used data from a prospective sCJD surveillance study in Germany (2016-2022) and publicly available datasets of SARS-CoV-2 cases and vaccination numbers in Germany for the years 2020-2022. Associations of SARS-CoV-2 incidence and immunisation rates with sCJD incidence were assessed by comparing quarterly and annual cumulative sCJD incidences in the periods before (2016-2019) and during the pandemic (2020-2022).</p><p><strong>Results: </strong>We could not identify any time-related effect of SARS-CoV-2 incidence or immunisation rate on the sCJD incidence. Moreover, we did not find any sCJD incidence alterations before and during the SARS-CoV-2 pandemic on a federal or state level. The overall sCJD incidence was within expected ranges in the years 2020-2022. There were no changes in age of onset and clinical disease duration in these years.</p><p><strong>Conclusions: </strong>We found no evidence supporting a short-term effect of the pandemic on sCJD incidence. However, considering the extended pre-clinical phase of sCJD, continued surveillance is needed to identify potential future incidence alterations.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"64-69"},"PeriodicalIF":5.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138813155","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of Multiple Sclerosis in Uruguay: A Prospective Population-Based Study.","authors":"Valeria Rocha, Noelia Sorondo, Fabián Gómez, Lucía Castro, Daniel Ontaneda, Carlos Ketzoian","doi":"10.1159/000538221","DOIUrl":"10.1159/000538221","url":null,"abstract":"<p><strong>Background: </strong>The worldwide incidence of multiple sclerosis (MS) is estimated at 0.5-10 cases per 100,000 person-years and is probably increasing. In 2014, a previous study estimated the incidence of multiple sclerosis in Uruguay at 1.2 cases per 100,000 person-years.</p><p><strong>Objectives: </strong>We conducted an observational, prospective, population-based study to determine MS incidence from diagnosis in Uruguay.</p><p><strong>Methods: </strong>The population studied included people older than 18 years of age who were living in Uruguay between July 1, 2019, and June 30, 2021. The diagnosis was based on 2017 McDonald criteria. Multiple data sources were employed including neurologists, magnetic resonance imaging centers, laboratories performing oligoclonal band testing, neurophysiology laboratories, neurorehabilitation centers, the institution Fondo Nacional de Recursos, and the MS Patients' Association of Uruguay (EMUR). The capture-recapture method was used to estimate incidence.</p><p><strong>Results: </strong>155 new MS cases were confirmed after review. The median age was 35 (range 18-62). Thirteen patients (8.38%) were diagnosed with late-onset MS. The crude incidence rate was 2.89 cases per 100,000 person-years, 3.95 among females, and 1.72 among male patients. The incidence rate estimated using the capture-recapture method was 3.18 (95% CI: 3.02-3.34).</p><p><strong>Conclusions: </strong>According to the Atlas of MS, Uruguay has a low incidence rate (2.0-3.99), even though it is one of the highest in Latin America. Our country aligns with the global trend of increasing incidence. Age and sex distribution were similar to other studies, with a high incidence of patients with late-onset multiple sclerosis. The capture-recapture method confirms the exhaustivity of our investigation.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"317-325"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140112157","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between Sleep Disorders and Impulsive-Compulsive Behaviors in Parkinson's Disease: A Prospective Cohort Study.","authors":"Meijie Ye, Xiaoying Kang, Ida K Karlsson, Yu Wang, Qianqian Ji, Qi Liu, Xiaowei Xu, Sara Hägg, Fang Fang, Karin Wirdefeldt, Yiqiang Zhan","doi":"10.1159/000536555","DOIUrl":"10.1159/000536555","url":null,"abstract":"<p><strong>Objective: </strong>To examine the associations of excessive daytime sleepiness (EDS) and probable rapid eye movement sleep behavior disorder (pRBD), respectively, with impulsive-compulsive behaviors (ICBs) over a 5-year follow-up in patients with early Parkinson's disease (PD).</p><p><strong>Methods: </strong>The Parkinson's Progression Markers Initiative is a multicenter cohort study based on an ongoing and open-ended registry. Longitudinal associations of sleep disorders with ICB over 5-year follow-up visits were estimated using generalized linear mixed-effects models among PD participants.</p><p><strong>Results: </strong>A total of 825 PD participants were enrolled at baseline. The study sample had a median baseline age of 63.1 (interquartile range: 55.6-69.3) years and comprised 496 (61.5%) men. Among them, 201 (24.9%) had ICB at baseline. In the generalized mixed-effects models, EDS (odds ratio [OR] = 1.09, 95% confidence interval [CI] 1.05, 1.12) and RBD (OR = 1.07, 95% CI 1.03, 1.12) were substantially associated with higher odds of developing ICB over time in PD patients, after multivariate adjustment including age, gender, family history, GDS score, STAI-Y score, MDS-UPDRS part III score, LEDD, and disease duration. Consistent results were observed when stratifying by age at baseline, gender, and PD family history.</p><p><strong>Conclusions: </strong>The study findings suggest a longitudinal association between EDS and pRBD with an increased risk of developing ICB in patients with PD. The findings emphasize the significance of evaluating and addressing sleep disorders in PD patients as a potential approach to managing ICB.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"256-263"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11302741/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139704029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alcohol Use Disorder in the General Population in Sub-Saharan Africa.","authors":"Thibaut Gellé, Daniells Erazo, Damega Wenkourama, Aude Paquet, Murielle Girard, Philippe Nubukpo","doi":"10.1159/000534675","DOIUrl":"10.1159/000534675","url":null,"abstract":"<p><strong>Introduction: </strong>Alcohol use disorder (AUD) is one of the major risk factors for population health worldwide. In some regions, this disorder remains underdiagnosed. This is particularly the case in sub-Saharan Africa, where data on this disease in the general population remains scarce. The aim of this review was to describe the characteristics of AUD in sub-Saharan Africa.</p><p><strong>Methods: </strong>We have conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Web of Science, African Journals Online, African Index Medicus, PsycINFO, Cochrane, and Scopus were investigated. Studies were included if they were conducted in a general population using a validated assessment tool.</p><p><strong>Results: </strong>A total of 16 articles were selected and were conducted in 8 sub-Saharan African countries. The prevalence of AUD ranged from 0.1% to 33.2% in Nigeria. The most commonly used screening tool was the Alcohol Use Disorders Test (AUDIT), and among the factors associated with the AUD, we find mainly male gender, low income, Catholic religion, and the presence of a psychiatric comorbidity.</p><p><strong>Conclusion: </strong>In sub-Saharan Africa, too few studies have investigated the AUD in the general population with validated diagnostic tools. Prevalence data seem to vary widely between and even within countries. The main factors associated with AUD are those found in the Western literature. The wide variety of assessment tools used to screen for AUD makes it difficult to compare prevalences across countries.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"15-22"},"PeriodicalIF":3.2,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondhand Smoke Exposure and Risk of Dementia in Nonsmokers: A Population-Based Cohort Study.","authors":"Zhongxiao Wan, Xiaohui Zhang, Huanying He, Yebing Zhang, Guo-Chong Chen, Li-Qiang Qin, Na Zhang, Fu-Rong Li","doi":"10.1159/000535828","DOIUrl":"10.1159/000535828","url":null,"abstract":"<p><strong>Background: </strong>Large population-based prospective studies are necessary to provide clarification on the associations of panoramic secondhand smoking burden, including prenatal and postnatal secondhand smoke (SHS) exposure, with the risk of developing dementia.</p><p><strong>Methods: </strong>Our study comprised a sample of 353,756 dementia-free individuals from the UK Biobank who were nonsmokers had data on the exposure of maternal smoking as well as SHS exposure in daily life, which was quantified in terms of hours per week (h/week) and whether they lived with household smokers. Multivariable Cox regression models were utilized to analyze the independent and joint associations of maternal smoking and daily life SHS exposure with dementia risk.</p><p><strong>Results: </strong>During a median follow-up of 11.8 years, 4,113 participants developed dementia. Compared with those who lived in the environment without smokers, multivariable-adjusted hazard ratios (HRs) (95% CIs) were 1.11 (1.02, 1.20) and 1.31 (1.13, 1.52) for those who exposed to SHS for &gt;0 but ≤4 h/week and &gt;4 h/week, respectively, and was 1.25 (1.13, 1.39) for those who lived with smokers in the household. A positive history of maternal smoking was associated with a modestly higher risk of dementia (HR = 1.07; 95% CI: 1.01, 1.15). Furthermore, compared with participants with neither history of maternal smoking nor exposure to SHS, a particularly higher risk of dementia was observed among those with both exposures (HR = 1.48; 95% CI: 1.18, 1.86). Additionally, the HR (95% CI) was 1.32 (1.10, 1.59) when comparing participants with a history of maternal smoking who lived with smokers in their households with those who had neither exposures.</p><p><strong>Conclusions: </strong>Having a history of maternal smoking, longer exposure to SHS, and living with smokers in the household were each associated with an increased risk of developing dementia. Individuals who were simultaneously exposed to maternal smoking and SHS or lived with household smokers had a particularly higher dementia risk.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"166-173"},"PeriodicalIF":5.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Thrombectomy with or without Bridging Thrombolysis in Acute Ischemic Stroke: A Cost-Effectiveness Analysis.","authors":"Rami Z Morsi, Yuan Zhang, Meng Zhu, Shitong Xie, Julián Carrión-Penagos, Harsh Desai, Elie Tannous, Sachin A Kothari, Assem Khamis, Andrea J Darzi, Ammar Tarabichi, Reena Bastin, Layal Hneiny, Sonam Thind, James E Siegler, Elisheva R Coleman, Scott J Mendelson, Ali Mansour, Shyam Prabhakaran, Tareq Kass-Hout","doi":"10.1159/000535796","DOIUrl":"10.1159/000535796","url":null,"abstract":"<p><strong>Background: </strong>There is unclear added benefit of intravenous thrombolysis (IVT) with endovascular thrombectomy (EVT). We performed a cost-effectiveness analysis to assess the cost-effectiveness of comparing EVT with IVT versus EVT alone.</p><p><strong>Methods: </strong>We used a decision tree to examine the short-term costs and outcomes at 90 days after the occurrence of index stroke to compare the cost-effectiveness of EVT alone with EVT plus IVT for patients with stroke. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. We estimated total and incremental cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio.</p><p><strong>Results: </strong>The average costs per patient were estimated to be $47,304, $49,510, $59,770, and $76,561 for EVT-only strategy and $55,482, $57,751, $68,314, and $85,611 for EVT with IVT over 90 days, 1 year, 5 years, and 20 years, respectively. The cost saving of EVT-only strategy was driven by the avoided medication costs of IVT (ranging from $8,178 to $9,050). The additional IVT led to a slight decrease in QALY estimate during the 90-day time horizon (loss of 0.002 QALY), but a small gain over 1-year and 5-year time horizons (0.011 and 0.0636 QALY). At a willingness-to-pay threshold of $50,000 per QALY gained, the probabilities of EVT only being cost-effective were 100%, 100%, and 99.3% over 90-day, 1-year, and 5-year time horizons.</p><p><strong>Conclusion: </strong>Our cost-effectiveness model suggested that EVT only may be cost-effective for patients with acute ischemic stroke secondary to large vessel occlusion.</p>","PeriodicalId":54730,"journal":{"name":"Neuroepidemiology","volume":" ","pages":"47-56"},"PeriodicalIF":5.7,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10857025/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138833044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}