Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study

  1. van Voorst, Henk ORCID logo
  2. Hoving, Jan W.
  3. Koopman, Miou S.
  4. Daems, Jasper D.
  5. Peerlings, Daan
  6. Buskens, Erik
  7. Lingsma, Hester F.
  8. Beenen, Ludo F. M.
  9. de Jong, Hugo W. A. M.
  10. Berkhemer, Olvert A.
  11. van Zwam, Wim H.
  12. Roos, Yvo B. W. E. M.
  13. van Walderveen, Marianne A. A.
  14. van den Wijngaard, Ido
  15. Dippel, Diederik W. J.
  16. Yoo, Albert J.
  17. Campbell, Bruce C. V.
  18. Kunz, Wolfgang G.
  19. Emmer, Bart J.
  20. Majoie, Charles B. L. M.
  21. for the CLEOPATRA investigators
  22. for the CONTRAST consortium
  23. van Nuland, Rick
  24. van der Lugt, Aad
  25. van Es, Adriaan
  26. van Doormaal, Pieter-Jan
  27. van den Berg, René
  28. Beenen, Ludo F. M.
  29. Roosendaal, Stefan D.
  30. Postma, Alida Annechien
  31. Yo, Lonneke S. F.
  32. Krietemeijer, G. Menno
  33. Nijeholt, Geert J. Lycklama à
  34. Martens, Jasper M.
  35. Hammer, Sebastiaan
  36. Meijer, Anton
  37. Bokkers, Reinoud P. H.
  38. van der Hoorn, Anouk
  39. Gerrits, Dick
  40. van Oostenbrugge, Robert
  41. Coutinho, Jonathan M.
  42. Truijman, Martine
  43. Staals, Julie
  44. van der Worp, H. Bart
  45. Boogaarts, J.
  46. Jansen, Ben
  47. Zinkstok, Sanne
  48. Truijman, Martine
  49. Staals, Julie
  50. Koudstaal, Peter
  51. Keizer, Koos
  52. Manschot, Sanne
  53. Boiten, Jelis
  54. Kerkhoff, Henk
  55. Chalos, Vicky
  56. Versteeg, Adriaan
  57. Wolff, Lennard
  58. van der Sluijs, Matthijs
  59. Tolhuisen, Manon L.
  60. Cate, Hugo ten
  61. de Maat, Moniek
  62. Donse-Donkel, Samantha
  63. van Beusekom, Heleen
  64. Taha, Aladdin
  65. Barakzie, Aarazo
  66. van de Graaf, Rob
  67. van der Steen, Wouter
  68. Treurniet, Kilian M.
  69. van den Berg, Sophie
  70. LeCouffe, Natalie
  71. Kappelhof, Manon
  72. Reinink, Rik
  73. Rinkel, Leon
  74. Brouwer, Josje
  75. Bruggeman, Agnetha
  76. Goldhoorn, Robert-Jan
  77. Hinsenveld, Wouter
  78. Pirson, Anne
  79. Olthuis, Susan
  80. Venema, Simone Uniken
  81. Teeselink, Sjan
  82. Sondag, Lotte
  83. Collette, Sabine
  84. Sterrenberg, Martin
  85. Ghannouti, Naziha el
  86. van der Steen, Laurine
  87. Verheesen, Sabrina
  88. Vranken, Jeannique
  89. van Ahee, Ayla
  90. Bongenaar, Hester
  91. Smallegange, Maylee
  92. Tilet, Lida
  93. de Meris, Joke
  94. Simons, Michelle
  95. Pellikaan, Wilma
  96. van Wijngaarden, Wilma
  97. Blauwendraat, Kitty
  98. Drabbe, Yvonne
  99. Sandiman-Lefeber, Michelle
  100. Katthöfer, Anke
  101. Ponjee, Eva
  102. Eilander, Rieke
  103. van Loon, Anja
  104. Kraus, Karin
  105. Kooij, Suze
  106. Slotboom, Annemarie
  107. van der Minne, Friedus
  108. Santegoets, Esther
  109. Heiligers, Leontien
  110. Martens, Yvonne
  111. for the MR CLEAN Registry Investigators
  112. Vos, Jan Albert
  113. Jansen, Ivo G. H.
  114. Mulder, Maxim J. H. L.
  115. Compagne, Kars C. J.
  116. den Hartog, Sanne J.
  117. Roozenbeek, Bob
  118. Schonewille, Wouter J.
  119. Wermer, Marieke J. H.
  120. Hofmeijer, Jeannette
  121. Nijeholt, Geert J. Lycklama à
  122. de Bruijn, Sebastiaan F.
  123. van Dijk, Lukas C.
  124. Lo, Rob H.
  125. van Dijk, Ewoud J.
  126. Boogaarts, Hieronymus D.
  127. de Vries, J.
  128. de Kort, Paul L. M.
  129. van Tuijl, Julia
  130. Peluso, Jo P.
  131. Fransen, Puck
  132. van den Berg, Jan S. P.
  133. van Hasselt, Boudewijn A. A. M.
  134. Aerden, Leo A. M.
  135. Dallinga, René J.
  136. Uyttenboogaart, Maarten
  137. Eschgi, Omid
  138. Schreuder, Tobien H. C. M. L.
  139. Heijboer, Roel J. J.
  140. Keizer, Koos
  141. den Hertog, Heleen M.
  142. Sturm, Emiel J. C.
  143. Sprengers, Marieke E. S.
  144. Jenniskens, Sjoerd F. M.
  145. van der Kallen, Bas F. W.
  146. Bot, Joost
  147. Ghariq, Elyas
  148. van Proosdij, Marc P.
  149. Dinkelaar, Wouter
  150. Appelman, Auke P. A.
  151. Hammer, Bas
  152. Pegge, Sjoert
  153. Vinke, Saman
  154. Flach, H. Zwenneke
  155. Sprengers, Rita
  156. Elfrink, Marjan
  157. Vossers, Marjolein
  158. de Meris, Joke
  159. Vermeulen, Tamara
  160. Geerlings, Annet
  161. van Vemde, Gina
  162. Simons, Tiny
  163. Messchendorp, Gert
  164. Nicolaij, Nynke
  165. Bodde, Karin
  166. Kleijn, Sandra
  167. Lodico, Jasmijn
  168. Droste, Hanneke
  169. Wollaert, Maureen
  170. Jeurrissen, D.
  171. Bos, Erna
  172. Sandiman, Michelle
  173. Aaldering, Nicoline
  174. Zweedijk, Berber
  175. Vervoort, Jocova
  176. Romviel, Sharon
  177. Kanselaar, Karin
  178. Barning, Denn
  179. Venema, Esmee
  180. Geuskens, Ralph R.
  181. van Straaten, Tim
  182. Ergezen, Saliha
  183. Harmsma, Roger R. M.
  184. Muijres, Daan
  185. de Jong, Anouk
  186. Boers, Anna M. M.
  187. Groot, P. F. C.
  188. Mens, Marieke A.
  189. van Kranendonk, Katinka R.
  190. Alves, Heitor
  191. Weterings, Annick J.
  192. Kirkels, Eleonora L. F.
  193. Voogd, Eva J. H. F.
  194. Schupp, Lieve M.
  195. Groot, Adrien E. D.
  196. Konduri, Praneeta R.
  197. Prasetya, Haryadi
  198. Arrarte-Terreros, Nerea
  199. Ramos, Lucas A.

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1000 Titel
  • Cost-effectiveness of CT perfusion for the detection of large vessel occlusion acute ischemic stroke followed by endovascular treatment: a model-based health economic evaluation study
1000 Autor/in
  1. van Voorst, Henk |
  2. Hoving, Jan W. |
  3. Koopman, Miou S. |
  4. Daems, Jasper D. |
  5. Peerlings, Daan |
  6. Buskens, Erik |
  7. Lingsma, Hester F. |
  8. Beenen, Ludo F. M. |
  9. de Jong, Hugo W. A. M. |
  10. Berkhemer, Olvert A. |
  11. van Zwam, Wim H. |
  12. Roos, Yvo B. W. E. M. |
  13. van Walderveen, Marianne A. A. |
  14. van den Wijngaard, Ido |
  15. Dippel, Diederik W. J. |
  16. Yoo, Albert J. |
  17. Campbell, Bruce C. V. |
  18. Kunz, Wolfgang G. |
  19. Emmer, Bart J. |
  20. Majoie, Charles B. L. M. |
  21. for the CLEOPATRA investigators |
  22. for the CONTRAST consortium |
  23. van Nuland, Rick |
  24. van der Lugt, Aad |
  25. van Es, Adriaan |
  26. van Doormaal, Pieter-Jan |
  27. van den Berg, René |
  28. Beenen, Ludo F. M. |
  29. Roosendaal, Stefan D. |
  30. Postma, Alida Annechien |
  31. Yo, Lonneke S. F. |
  32. Krietemeijer, G. Menno |
  33. Nijeholt, Geert J. Lycklama à |
  34. Martens, Jasper M. |
  35. Hammer, Sebastiaan |
  36. Meijer, Anton |
  37. Bokkers, Reinoud P. H. |
  38. van der Hoorn, Anouk |
  39. Gerrits, Dick |
  40. van Oostenbrugge, Robert |
  41. Coutinho, Jonathan M. |
  42. Truijman, Martine |
  43. Staals, Julie |
  44. van der Worp, H. Bart |
  45. Boogaarts, J. |
  46. Jansen, Ben |
  47. Zinkstok, Sanne |
  48. Truijman, Martine |
  49. Staals, Julie |
  50. Koudstaal, Peter |
  51. Keizer, Koos |
  52. Manschot, Sanne |
  53. Boiten, Jelis |
  54. Kerkhoff, Henk |
  55. Chalos, Vicky |
  56. Versteeg, Adriaan |
  57. Wolff, Lennard |
  58. van der Sluijs, Matthijs |
  59. Tolhuisen, Manon L. |
  60. Cate, Hugo ten |
  61. de Maat, Moniek |
  62. Donse-Donkel, Samantha |
  63. van Beusekom, Heleen |
  64. Taha, Aladdin |
  65. Barakzie, Aarazo |
  66. van de Graaf, Rob |
  67. van der Steen, Wouter |
  68. Treurniet, Kilian M. |
  69. van den Berg, Sophie |
  70. LeCouffe, Natalie |
  71. Kappelhof, Manon |
  72. Reinink, Rik |
  73. Rinkel, Leon |
  74. Brouwer, Josje |
  75. Bruggeman, Agnetha |
  76. Goldhoorn, Robert-Jan |
  77. Hinsenveld, Wouter |
  78. Pirson, Anne |
  79. Olthuis, Susan |
  80. Venema, Simone Uniken |
  81. Teeselink, Sjan |
  82. Sondag, Lotte |
  83. Collette, Sabine |
  84. Sterrenberg, Martin |
  85. Ghannouti, Naziha el |
  86. van der Steen, Laurine |
  87. Verheesen, Sabrina |
  88. Vranken, Jeannique |
  89. van Ahee, Ayla |
  90. Bongenaar, Hester |
  91. Smallegange, Maylee |
  92. Tilet, Lida |
  93. de Meris, Joke |
  94. Simons, Michelle |
  95. Pellikaan, Wilma |
  96. van Wijngaarden, Wilma |
  97. Blauwendraat, Kitty |
  98. Drabbe, Yvonne |
  99. Sandiman-Lefeber, Michelle |
  100. Katthöfer, Anke |
  101. Ponjee, Eva |
  102. Eilander, Rieke |
  103. van Loon, Anja |
  104. Kraus, Karin |
  105. Kooij, Suze |
  106. Slotboom, Annemarie |
  107. van der Minne, Friedus |
  108. Santegoets, Esther |
  109. Heiligers, Leontien |
  110. Martens, Yvonne |
  111. for the MR CLEAN Registry Investigators |
  112. Vos, Jan Albert |
  113. Jansen, Ivo G. H. |
  114. Mulder, Maxim J. H. L. |
  115. Compagne, Kars C. J. |
  116. den Hartog, Sanne J. |
  117. Roozenbeek, Bob |
  118. Schonewille, Wouter J. |
  119. Wermer, Marieke J. H. |
  120. Hofmeijer, Jeannette |
  121. Nijeholt, Geert J. Lycklama à |
  122. de Bruijn, Sebastiaan F. |
  123. van Dijk, Lukas C. |
  124. Lo, Rob H. |
  125. van Dijk, Ewoud J. |
  126. Boogaarts, Hieronymus D. |
  127. de Vries, J. |
  128. de Kort, Paul L. M. |
  129. van Tuijl, Julia |
  130. Peluso, Jo P. |
  131. Fransen, Puck |
  132. van den Berg, Jan S. P. |
  133. van Hasselt, Boudewijn A. A. M. |
  134. Aerden, Leo A. M. |
  135. Dallinga, René J. |
  136. Uyttenboogaart, Maarten |
  137. Eschgi, Omid |
  138. Schreuder, Tobien H. C. M. L. |
  139. Heijboer, Roel J. J. |
  140. Keizer, Koos |
  141. den Hertog, Heleen M. |
  142. Sturm, Emiel J. C. |
  143. Sprengers, Marieke E. S. |
  144. Jenniskens, Sjoerd F. M. |
  145. van der Kallen, Bas F. W. |
  146. Bot, Joost |
  147. Ghariq, Elyas |
  148. van Proosdij, Marc P. |
  149. Dinkelaar, Wouter |
  150. Appelman, Auke P. A. |
  151. Hammer, Bas |
  152. Pegge, Sjoert |
  153. Vinke, Saman |
  154. Flach, H. Zwenneke |
  155. Sprengers, Rita |
  156. Elfrink, Marjan |
  157. Vossers, Marjolein |
  158. de Meris, Joke |
  159. Vermeulen, Tamara |
  160. Geerlings, Annet |
  161. van Vemde, Gina |
  162. Simons, Tiny |
  163. Messchendorp, Gert |
  164. Nicolaij, Nynke |
  165. Bodde, Karin |
  166. Kleijn, Sandra |
  167. Lodico, Jasmijn |
  168. Droste, Hanneke |
  169. Wollaert, Maureen |
  170. Jeurrissen, D. |
  171. Bos, Erna |
  172. Sandiman, Michelle |
  173. Aaldering, Nicoline |
  174. Zweedijk, Berber |
  175. Vervoort, Jocova |
  176. Romviel, Sharon |
  177. Kanselaar, Karin |
  178. Barning, Denn |
  179. Venema, Esmee |
  180. Geuskens, Ralph R. |
  181. van Straaten, Tim |
  182. Ergezen, Saliha |
  183. Harmsma, Roger R. M. |
  184. Muijres, Daan |
  185. de Jong, Anouk |
  186. Boers, Anna M. M. |
  187. Groot, P. F. C. |
  188. Mens, Marieke A. |
  189. van Kranendonk, Katinka R. |
  190. Alves, Heitor |
  191. Weterings, Annick J. |
  192. Kirkels, Eleonora L. F. |
  193. Voogd, Eva J. H. F. |
  194. Schupp, Lieve M. |
  195. Groot, Adrien E. D. |
  196. Konduri, Praneeta R. |
  197. Prasetya, Haryadi |
  198. Arrarte-Terreros, Nerea |
  199. Ramos, Lucas A. |
1000 Verlag Springer Berlin Heidelberg
1000 Erscheinungsjahr 2023
1000 Publikationstyp
  1. Artikel |
1000 Online veröffentlicht
  • 2023-09-20
1000 Erschienen in
1000 Quellenangabe
  • 34(4):2152-2167
1000 Copyrightjahr
  • 2023
1000 Lizenz
1000 Verlagsversion
  • https://doi.org/10.1007/s00330-023-10119-y |
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10957700/ |
1000 Publikationsstatus
1000 Begutachtungsstatus
1000 Sprache der Publikation
1000 Abstract/Summary
  • <jats:title>Abstract</jats:title><jats:sec> <jats:title>Objectives</jats:title> <jats:p>CT perfusion (CTP) has been suggested to increase the rate of large vessel occlusion (LVO) detection in patients suspected of acute ischemic stroke (AIS) if used in addition to a standard diagnostic imaging regime of CT angiography (CTA) and non-contrast CT (NCCT). The aim of this study was to estimate the costs and health effects of additional CTP for endovascular treatment (EVT)–eligible occlusion detection using model-based analyses.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>In this Dutch, nationwide retrospective cohort study with model-based health economic evaluation, data from 701 EVT-treated patients with available CTP results were included (January 2018–March 2022; trialregister.nl:NL7974). We compared a cohort undergoing NCCT, CTA, and CTP (NCCT + CTA + CTP) with a generated counterfactual where NCCT and CTA (NCCT + CTA) was used for LVO detection. The NCCT + CTA strategy was simulated using diagnostic accuracy values and EVT effects from the literature. A Markov model was used to simulate 10-year follow-up. We adopted a healthcare payer perspective for costs in euros and health gains in quality-adjusted life years (QALYs). The primary outcome was the net monetary benefit (NMB) at a willingness to pay of €80,000; secondary outcomes were the difference between LVO detection strategies in QALYs (ΔQALY) and costs (ΔCosts) per LVO patient.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p>We included 701 patients (median age: 72, IQR: [62–81]) years). Per LVO patient, CTP-based occlusion detection resulted in cost savings (ΔCosts median: € − 2671, IQR: [€ − 4721; € − 731]), a health gain (ΔQALY median: 0.073, IQR: [0.044; 0.104]), and a positive NMB (median: €8436, IQR: [5565; 11,876]) per LVO patient.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusion</jats:title> <jats:p>CTP-based screening of suspected stroke patients for an endovascular treatment eligible large vessel occlusion was cost-effective.</jats:p> </jats:sec><jats:sec> <jats:title>Clinical relevance statement.</jats:title> <jats:p>Although CTP-based patient selection for endovascular treatment has been recently suggested to result in worse patient outcomes after ischemic stroke, an alternative CTP-based screening for endovascular treatable occlusions is cost-effective.</jats:p> </jats:sec><jats:sec> <jats:title>Key Points</jats:title> <jats:p><jats:italic>• Using CT perfusion to detect an endovascular treatment-eligible occlusions resulted in a health gain and cost savings during 10 years of follow-up.</jats:italic></jats:p> <jats:p><jats:italic>• Depending on the screening costs related to the number of patients needed to image with CT perfusion, cost savings could be considerable (median: € − 3857, IQR: [€ − 5907; € − 1916] per patient).</jats:italic></jats:p> <jats:p><jats:italic>• As the gain in quality adjusted life years was most affected by the sensitivity of CT perfusion-based occlusion detection, additional studies for the diagnostic accuracy of CT perfusion for occlusion detection are required.</jats:italic></jats:p> </jats:sec>
1000 Sacherschließung
lokal Ischemic Stroke/therapy [MeSH]
lokal Stroke/therapy [MeSH]
lokal Thrombectomy [MeSH]
lokal Cost-Benefit Analysis [MeSH]
lokal Health Care Economics and Organizations
lokal Aged [MeSH]
lokal Humans [MeSH]
lokal Four-dimensional computed tomography
lokal Retrospective Studies [MeSH]
lokal Computed Tomography Angiography/methods [MeSH]
lokal Tomography, X-Ray Computed/methods [MeSH]
lokal Brain Ischemia/drug therapy [MeSH]
lokal Thrombectomy
lokal Health Economy
lokal Ischemic Stroke/diagnostic imaging [MeSH]
lokal Stroke/diagnostic imaging [MeSH]
lokal Perfusion [MeSH]
lokal Diagnosis
lokal Brain Ischemia/therapy [MeSH]
lokal Ischemic stroke
1000 Fächerklassifikation (DDC)
1000 Liste der Beteiligten
  1. 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  • DeepGreen-ID: c4b540aa95f449248c99784f5a790d99 ; metadata provieded by: DeepGreen (https://www.oa-deepgreen.de/api/v1/), LIVIVO search scope life sciences (http://z3950.zbmed.de:6210/livivo), Crossref Unified Resource API (https://api.crossref.org/swagger-ui/index.html), to.science.api (https://frl.publisso.de/), ZDB JSON-API (beta) (https://zeitschriftendatenbank.de/api/), lobid - Dateninfrastruktur für Bibliotheken (https://lobid.org/resources/search)
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1000 @id frl:6518549.rdf
1000 Erstellt am 2025-07-05T12:01:02.966+0200
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1000 Zuletzt bearbeitet 2025-08-15T20:32:20.614+0200
1000 Objekt bearb. Fri Aug 15 20:32:20 CEST 2025
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