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Cost-effectiveness analysis of mechanical thrombectomy in acute ischemic stroke

Clinical article

Chirag G. Patil, Elisa F. Long, and Maarten G. Lansberg

with patients without recanalization. 7 , 10 , 13 , 14 Decisions concerning the clinical utility of an intervention should be guided by information regarding the benefits, risks, and costs associated with that intervention. Cost-effectiveness analysis is a tool that can be used to assess outcomes and costs in a unified model. The objective of our analysis was to determine whether mechanical thrombectomy for acute ischemic stroke is cost-effective from a societal perspective. Methods Model Overview To determine the cost-effectiveness of mechanical

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Impact of collateral flow on cost-effectiveness of endovascular thrombectomy

Mihir Khunte, Xiao Wu, Emily W. Avery, Dheeraj Gandhi, Seyedmehdi Payabvash, Charles Matouk, Jeremy J. Heit, Max Wintermark, Gregory W. Albers, Pina Sanelli, and Ajay Malhotra

benefit with EVT across all strata of collateral circulation status, albeit with lesser benefit in patients with poor collaterals relative to those with better collaterals. 11 The impact of collateral flow on cost-effectiveness of EVT is not well understood. Expanding EVT to patients with poor and intermediate collaterals should be considered in terms of expected health benefits and associated costs from a long-term, societal perspective. On the other hand, the decision not to offer EVT to patients with poor collaterals requires consideration of the implications of

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Cost-effectiveness of current treatment strategies for lumbar spinal stenosis: nonsurgical care, laminectomy, and X-STOP

Clinical article

Mark G. Burnett, Sherman C. Stein, and Ronald H. M. A. Bartels

, 17 , 26 Others have examined the direct costs of the X-STOP procedure and found that it compares favorably to laminectomy. 33 In the present study, we use clinical outcomes data available in the literature as well as current medical treatment cost data to perform a cost-effectiveness analysis of X-STOP placement versus laminectomy for LSS. Methods We performed a MEDLINE search of the English-language literature, using combinations of the MESH headings “spinal stenosis” and “spondylolisthesis,” in conjunction with any of the following subheadings

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Cost-effectiveness analysis of radiosurgical capsulotomy versus treatment as usual for treatment-resistant obsessive-compulsive disorder

Ricardo A. Najera, Sean T. Gregory, Ben Shofty, Adrish Anand, Ron Gadot, Brett E. Youngerman, Eric A. Storch, Wayne K. Goodman, and Sameer A. Sheth

radiosurgical capsulotomy (SRS-C) is an effective neurosurgical option for patients with TROCD, with response rates (≥ 35% reduction in the Y-BOCS score) of 50%–66%. 16 , 17 However, unlike with procedures of comparable efficacy, such as DBS 21 , 22 and radiofrequency ablation, 23 the cost and cost-effectiveness of SRS-C have not been investigated. One Dutch study found DBS for OCD to be more cost-effective than TAU in 50%–87% of cases, depending on battery rechargeability, with increasing cost-effectiveness over time. 21 Another study showed DBS for OCD to be more cost

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Cost-effectiveness of transforaminal lumbar interbody fusion for Grade I degenerative spondylolisthesis

Clinical article

Owoicho Adogwa, Scott L. Parker, Brandon J. Davis, Oran Aaronson, Clinton Devin, Joseph S. Cheng, and Matthew J. McGirt

L ow -back and leg pain due to degenerative lumbar spondylolisthesis is occurring with increasing frequency and is associated with increasing public health implications as the US population older than 65 years of age grows. 1 , 11 , 14 , 18 A marked increase in spine fusion rates and corresponding aggregate health care costs over the past 2 decades are well documented. 5 , 19 , 20 Economic value is an increasingly important component of health care policy decision-making. Hence, much attention has recently been given to the cost-effectiveness of lumbar

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Cost-effectiveness of minimally invasive midline lumbar interbody fusion versus traditional open transforaminal lumbar interbody fusion

Mladen Djurasovic, Jeffrey L. Gum, Charles H. Crawford III, Kirk Owens II, Morgan Brown, Portia Steele, Steven D. Glassman, and Leah Y. Carreon

the cost-effectiveness of surgical interventions will be a major area of focus for spinal surgeons in the upcoming decades. Minimally invasive procedures have a unique potential to improve cost-effectiveness, as they often can hasten perioperative recovery and thus lower perioperative costs. 12 However, some of these procedures may necessitate more expensive implants, increasing supply costs and thus negating some of these positive effects. In addition, surgeon adoption has been somewhat limited by the unfamiliar oblique approach to the spinal canal and the limited

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Analyzing cost-effectiveness of ulnar and median nerve transfers to regain forearm flexion

Arvin R. Wali, Charlie C. Park, Justin M. Brown, and Ross Mandeville

elbow. Similarly, a fascicle of the median nerve transferred to the biceps branch of the musculocutaneous nerve is also effective in improving elbow flexion. 1 , 8 , 19 A double fascicular transfer that uses both ulnar and median nerve fascicles to reinnervate musculocutaneous branches to both biceps and brachialis muscles has been argued to provide additional strength. 16 Although prior studies have investigated the comparative efficacy of these nerve transfer procedures, 3 a cost-effectiveness study of surgical management compared with conservative management has

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Cost-effectiveness of adult spinal deformity surgery in a military healthcare system

Chris J. Neal, Kara Mandell, Ellen Tasikas, John J. Delaney, Charles A. Miller, Cody D. Schlaff, and Michael K. Rosner

required per QALY provides the basis for cost-effectiveness is currently judged to be $100,000/QALY. 2 , 8 , 9 , 18 An intervention is considered cost-effective when the cost/QALY is less than $100,000. Some have argued, though, that inflation needs to be taken into account. This is where the concept that 3 times the gross domestic product (GDP) per capita can be used as a threshold. 21 Based on the 2010 GDP per capita of the United States, this translates into $140,580/QALY, increasing to $154,458 based on 2015 data. 4 , 8 , 12 , 15 Per the World Bank website

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Cost-effectiveness of postoperative imaging surveillance strategies for nonfunctional pituitary adenomas after resection with curative intent

Lisa Caulley, Stijntje W. Dijk, Eline Krijkamp, Selina X. Dong, Fahad Alkherayf, Liza Amrani, Mary-Anne Doyle, Anas Eid, Stephanie Johnson-Obaseki, Michel Khoury, Janine Malcolm, Dorsa Mavedatnia, Nick Sahlollbey, David Schramm, Jonathan Whelan, Kednapa Thavorn, Shaun Kilty, and Myriam G. M. Hunink

cohort to the reported literature. 11 Analysis The incremental cost-effectiveness ratio (ICER), defined as the additional cost for each additional unit of health benefit (QALYs gained), was used as an efficiency metric. The commonly accepted willingness-to-pay (WTP) threshold of $100,000 US dollars was selected to signify the amount below which an intervention would be considered cost-effective. The net monetary benefit was presented as the benefit of the surveillance strategy expressed in monetary terms net of all costs. 26 A societal perspective was adopted

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Cost-effectiveness of remote robotic mechanical thrombectomy in acute ischemic stroke

Maria X. Sanmartin, Jeffrey M. Katz, Christian Eusemann, Artem T. Boltyenkov, Kinpritma Sangha, Mehrad Bastani, Raymond Turner, Adnan H. Siddiqui, Vitor Mendes Pereira, Ferdinand K. Hui, J Mocco, and Pina C. Sanelli

outcomes associated with an RR-EVT system needs to be performed given the potential reductions in lifetime healthcare costs and improved outcomes. We hypothesized that the RR-EVT system is associated with better clinical outcomes and reductions in downstream costs because the need to transfer a patient to a CSC/TSC is eliminated. In this study we aimed to model whether performing RR-EVT stroke interventions as opposed to standard of care might translate to cost-effectiveness in the US over a lifetime. Methods Model Design A decision-analytic model from a