Abstract Details

Title Cost Effectiveness of Decompressive Hemicraniectomy Versus Medical Management in Patients with Malignant Ischemic Stroke

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S22 - (-)

Poster/Presentation
Number 006

Objective

Background A pooled analysis of three randomized controlled trials demonstrated that decompressive hemicraniectomy, when performed within 48 hours of stroke onset reduces mortality and improves functional outcome in patients with malignant ischemic stroke. However, cost effectiveness of decompressive hemicraniectomy has not been studied.

Design/Methods The frequency distributions for disability according to modified Rankin Scale (mRS) at one year for both hemicraniectomy and conservative management groups were obtained from a pooled analysis of three randomized controlled trials of decompressive hemicraniectomy for malignant ischemic stroke. The quality adjusted life years (QALYs) were estimated by weighing the QALY at 1 year with the frequency of each mRS associated with each treatment modality. Cost of hospitalization was obtained from 2010 National Inpatient Survey (NIS), a nationally representative inpatient database in the United States. Cost of disability associated with moderate to severe stroke and cost of death were estimated from previously published data. Costs are expressed in United States dollars and are adjusted for inflation up to 2012. Incremental cost effectiveness ratio (ICER) was then estimated.

Results The estimated net cost for patients treated with decompressive hemicraniectomy and conservative management $200378 and $81840, respectively. The average QALYs were 0.35 for decompressive hemicraniectomy and 0.11 for conservative management, ranging from 0 (death) to 0.75 (mild disability).The cost per quality was $566039 for decompressive hemicraniectomy and $705517 for conservative management.

Conclusions Although previous data demonstrated reduced mortality and improved functional outcome with decompressive hemicraniectomy compared to conservative management, the benefit obtained may be off-set by the cost per quality it provides.

Authors/Disclosures
PRESENTER	No disclosure on file
Maurice M. Ohayon, MD, PhD, DSc (Stanford)	The institution of Dr. Ohayon has received research support from Jazz pharmaceuticals. The institution of Dr. Ohayon has received research support from Takeda Pharmaceuticals.
Tenbit Emiru, MD (UCare)	No disclosure on file
	No disclosure on file
Hamza I. Maqsood, MD (Dept of Neurology)	Dr. Qureshi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for AstraZeneca.

��ɫ��

��ɫ��