2 results
Cost-Effectiveness of Late Endovascular Thrombectomy vs. Best Medical Management in a Clinical Trial Setting and Real-World Setting
- Johanna Maria Ospel, Charlotte Zerna, Emma Harrison, Timothy J. Kleinig, Volker Puetz, Daniel P. O. Kaiser, Brett Graham, Amy Y.X. Yu, Brian van Adel, Jai J. Shankar, Ryan A. McTaggart, Vitor Pereira, Donald F. Frei, Wolfgang G. Kunz, Mayank Goyal, Michael D. Hill
-
- Journal:
- Canadian Journal of Neurological Sciences , First View
- Published online by Cambridge University Press:
- 26 February 2024, pp. 1-8
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background and purpose:
To assess cost-effectiveness of late time-window endovascular treatment (EVT) in a clinical trial setting and a “real-world” setting.
Methods:Data are from the randomized ESCAPE trial and a prospective cohort study (ESCAPE-LATE). Anterior circulation large vessel occlusion patients presenting > 6 hours from last-known-well were included, whereby collateral status was an inclusion criterion for ESCAPE but not ESCAPE-LATE. A Markov state transition model was built to estimate lifetime costs and quality-adjusted life-years (QALYs) for EVT in addition to best medical care vs. best medical care only in a clinical trial setting (comparing ESCAPE-EVT to ESCAPE control arm patients) and a “real-world” setting (comparing ESCAPE-LATE to ESCAPE control arm patients). We performed an unadjusted analysis, using 90-day modified Rankin Scale(mRS) scores as model input and analysis adjusted for baseline factors. Acceptability of EVT was calculated using upper/lower willingness-to-pay thresholds of 100,000 USD/50,000 USD/QALY.
Results:Two-hundred and forty-nine patients were included (ESCAPE-LATE:n = 200, ESCAPE EVT-arm:n = 29, ESCAPE control-arm:n = 20). Late EVT in addition to best medical care was cost effective in the unadjusted analysis both in the clinical trial and real-world setting, with acceptability 96.6%–99.0%. After adjusting for differences in baseline variables between the groups, late EVT was marginally cost effective in the clinical trial setting (acceptability:49.9%–61.6%), but not the “real-world” setting (acceptability:32.9%–42.6%).
Conclusion:EVT for LVO-patients presenting beyond 6 hours was cost effective in the clinical trial setting and “real-world” setting, although this was largely related to baseline patient differences favoring the “real-world” EVT group. After adjusting for these, EVT benefit was reduced in the trial setting, and absent in the real-world setting.
36 - Image-guided Ablation in the Thorax
- from PART III - ORGAN-SPECIFIC CANCERS
-
- By Ryan A. McTaggart, Radiology Resident, Brown University Hospital Providence, RI, Damian E. Dupuy, Director of Tumor, Ablation Rhode Island Hospital Professor of Diagnostic Imaging Brown Medical School Brown University Hospital Providence, RI, Thomas DiPetrillo, Associate Professor, Brown School of Medicine Vice Chairman, Department of Radiation Oncology Brown University Hospital Providence, RI
- Edited by Jean-François H. Geschwind, The Johns Hopkins University School of Medicine, Michael C. Soulen, University of Pennsylvania School of Medicine
-
- Book:
- Interventional Oncology
- Published online:
- 18 May 2010
- Print publication:
- 15 September 2008, pp 440-474
-
- Chapter
- Export citation
-
Summary
Surgical resection has been the mainstay of treatment for the minority of patients diagnosed with primary lung cancer and for selected patients with pulmonary metastatic disease. However, most patients with thoracic malignancies have little recourse other than the modest therapeutic benefits of chemotherapy or radiotherapy, which offer little chance for quality, prolonged survival.
Thermal ablation is an exciting new technique that offers clinicians and patients new hope with a repeatable, effective, low-cost, and safe treatment to effectively palliate and, in some cases, cure both primary and metastatic thoracic malignancies either before or concurrent with systemic therapy and radiotherapy.
The natural history of thoracic malignancies is of locoregional treatment failure and distant recurrence, except for non-small cell, primary lung cancers less than 2 cm in diameter, for which the likelihood of regional (extra-segmental) spread is small and surgery may be most appropriate. Although thermal ablation strategies have been used in patients with primary lung cancer who are too sick or have disease burdens that are too great for surgical therapy, most thoracic oncologists now recognize that primary lung cancer, like metastatic lung cancer, is a systemic disease with bewildering heterogeneity at the start, and that effective, local palliation and systemic therapy for both primary and metastatic thoracic cancer is the goal.
In this chapter, we discuss the basic physics of thermal ablation, applications for thermal ablation therapy in the thorax and technical considerations for thermal ablation.