Cost-Effectiveness of Thrombectomy With or Without Alteplase in Large Vessel Occlusion Stroke: A Meta-Analysis Considering Time-to-Treatment.

While early IVT may improve outcomes, delayed IVT administration lowers the likelihood of benefit.

虽然早期IVT可能会改善结果，但延迟IVT的使用会降低获益的可能性。

To date, no previous cost-effectiveness study has considered onset-to-treatment time.

迄今为止，尚无先前的成本效益研究考虑了发病至治疗时间。

This study evaluated the cost-effectiveness of intravenous (IV) alteplase plus thrombectomy vs thrombectomy alone in patients admitted directly to thrombectomy-capable centers across 16 countries, stratified by onset-to-IVT time.

本研究评估了在16个国家中，直接进入具备血栓切除术能力的中心的患者中，静脉注射（IV）阿替普酶加血栓切除术与单独血栓切除术的成本效益，按发病至IVT时间进行分层。

Methods

A decision tree integrated with a Markov model estimated costs, quality-adjusted life years (QALYs), and incremental net monetary benefit (INMB) over 15 years.

结合马尔可夫模型的决策树估计了15年内的成本、质量调整生命年（QALYs）和增量净货币效益（INMB）

A willingness-to-pay threshold of one gross domestic product per capita was applied for each country.

为每个国家应用了每人国内生产总值的支付意愿阈值

Effectiveness data were derived from individual patient data from 6 trials including patients with anterior circulation large-vessel occlusion eligible for both IVT and thrombectomy who presented directly to thrombectomy-capable centers.

有效性数据来自6项试验的个别患者数据，这些患者患有前循环大血管闭塞，适合接受静脉溶栓（IVT）和血栓切除术，并直接前往具备血栓切除能力的中心。

Costs were obtained from a literature review.

成本数据是通过文献综述获得的。

Onset-to-IVT time was categorized as <140, 140-169, 170-199, and ≥200 minutes.

发病至静脉溶栓（IVT）时间被分类为<140分钟、140-169分钟、170-199分钟和≥200分钟。

One-way sensitivity and probabilistic sensitivity analyses were performed to check robustness of results.

进行了一项单因素敏感性分析和概率敏感性分析，以检查结果的稳健性。

Results

Ninety-day functional outcome distributions from 2,268 patients (median age 71 years; 44% female) were used to model cost-effectiveness in a hypothetical cohort of 10,000 patients.

从2,268名患者（中位年龄71岁；44%为女性）的90天功能结果分布中，我们建立了一个假想的10,000名患者的成本效益模型。

Without accounting for onset-to-IVT time, IV alteplase plus thrombectomy seemed cost-effective in 13 countries (INMB: $85-$3,618; 50-65% probability of cost-effectiveness) and not cost-effective in the United States, China, and Vietnam, with modest health gains (0.06-0.08 QALYs per patient).

如果不考虑发病到静脉溶栓的时间，IV型阿替普酶加血栓切除术在13个国家似乎具有成本效益（INMB：$85-$3,618；成本效益概率为50-65%），而在美国、中国和越南则不具成本效益，健康收益适中（每位患者0.06-0.08 QALYs）。

Time-stratified analyses revealed that IVT plus thrombectomy was cost-effective in 16 countries when onset-to-IVT time was <140 minutes (INMB: $615-$30,645; 82%-98% probability) and at 140-169 minutes (INMB: $86-$16,918; 51%-77% probability).

分层时间分析显示，在16个国家中，当发病至静脉溶栓（IVT）时间小于140分钟时（增量净效益-INMB: $615-$30,645；概率为82%-98%），以及在140-169分钟时（INMB: $86-$16,918；概率为51%-77%），静脉溶栓加血栓切除术是具有成本效益的。

However, IV alteplase plus thrombectomy was no longer cost-effective in 8 countries at 170-199 minutes.

然而，在8个国家中，当发病至静脉溶栓时间在170-199分钟时，静脉注射阿替普酶加血栓切除术不再具有成本效益。

Universally, the INMB was negative for onset-to-IVT times exceeding 200 minutes.

普遍来看，对于起始至静脉溶栓（IVT）时间超过200分钟的情况，增量净效益（INMB）为负值。

Discussion

Cost-effectiveness of IV alteplase plus thrombectomy varies per country and onset-to-IVT time.

静脉注射阿替普酶联合血栓切除术的成本效益因国家和起始至静脉溶栓时间的不同而有所变化。

IV alteplase plus thrombectomy is cost-effective when IVT can be administered within 170 minutes from symptom onset.

在症状发作后170分钟内给予IV alteplase联合血栓切除术是具有成本效益的。

Cost-effectiveness of IV alteplase plus thrombectomy diminishes progressively with longer onset-to-IVT times and becomes detrimental after 200 minutes.

IV alteplase联合血栓切除术的成本效益随着发作到IVT时间的延长而逐渐降低，并在200分钟后变得不利。