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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
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Published on: January 18, 2018

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Cost-effectiveness of CT perfusion for patients with acute ischemic stroke (CLEOPATRA)-Study protocol for a

Miou S Koopman1, Jan W Hoving1, Henk van Voorst1,2

  • 1Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.

European Stroke Journal
|June 1, 2022
PubMed

Insights

This study estimates the costs and health effects of using computed tomography perfusion (CTP) to select patients with acute ischemic stroke (AIS) for endovascular thrombectomy (EVT). Results will inform CTP

Area of Science:

  • Health economics and outcomes research in neurovascular interventions.
  • Medical imaging and artificial intelligence in acute stroke management.
  • Clinical trial data analysis and health technology assessment.

Background:

  • Computed tomography perfusion (CTP) is used for endovascular thrombectomy (EVT) selection in acute ischemic stroke (AIS), but its role in the early (0-6h) window is debated.
  • The costs and health effects of incorporating CTP into EVT selection protocols, especially in the early time window, are not well understood.
  • Current guidelines recommend CTP for later time windows (6-24h) but not for earlier ones, creating uncertainty in clinical practice.

Purpose of the Study:

  • To estimate the costs and health effects associated with using CTP for EVT selection in AIS patients.
  • To compare CTP-based selection versus conventional selection strategies for EVT in AIS patients.
  • To provide data for developing recommendations on CTP use in AIS EVT selection across different time windows (0-24h).

Main Methods:

  • The CLEOPATRA study utilizes clinical and imaging data from prospective EVT trials and registries.
  • A Markov health state transition model simulates clinical outcomes over a 5-year period for CTP-based and conventional EVT selection.
  • The analysis incorporates data on event probabilities, costs, and Quality-Adjusted Life Years (QALYs) per modified Rankin Scale (mRS) subscore.

Main Results:

  • The primary outcome is the Incremental Cost-Effectiveness Ratio (ICER) per QALY gained over the 5-year simulation.
  • Cumulative outcome measures will be reported over the 5-year follow-up period.
  • The study provides preliminary insights into the cost-effectiveness of CTP for EVT selection in AIS.

Conclusions:

  • This research offers preliminary data on the economic and clinical value of CTP in EVT selection for AIS patients.
  • The findings aim to inform future clinical guidelines and implementation strategies for CTP use.
  • Understanding the cost-effectiveness of CTP can guide healthcare resource allocation for stroke interventions.
Abstract

Keywords:
CT perfusionStrokecost-effectivenessendovascular thrombectomy

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