부산대학교 도서관

Introduction:Encephaloduroarteriosynangiosis (EDAS) is being evaluated as a new treatment for symptomatic-intracranial-atherosclerotic-disease (sICAD) in high-risk patients. We present a cost-effectiveness analysis of EDAS compared with intensive-medical-management (IMM) for sICAD.Hypothesis:EDAS surgery is a cost-effective treatment for sICADMethods:Clinical data was obtained from the EDAS-Revascularization-for- Symptomatic-Intracranial-Atherosclerotic-Steno-occlusive-Performance-Criterion-trial (ERSIAS-PC) (n=52) and propensity scored matched cohorts from SAMMPRIS and COSS. Outcomes were projected at 3.5 years. Conservatively, treatment-effect was set as annual-risk-reduction (ARR) of 3.4%/year, 55% of the observed effect in stroke-death reduction in ERSIAS-PC. Total costs of procedure and IMM were calculated using disabling stroke, non-disabling stroke, or death rates per group, adjusted to 2021US$. The quality-adjusted-life-year (QALY) of each intervention was estimated using the frequency of disabling and non-disabling stroke, death, and baseline-health. Incremental cost-effectiveness-ratio (ICER) was formulated for 3.5-years.Results:Rates of stroke/death in ERSIAS PC were 9.6% (EDAS+IMM) and 21.2% (IMM). Estimated rates of stroke/death at 3.5 years were 27.9% (EDAS+IMM) and 38.9%(IMM). Calculated net-costs at 3.5-years were US$40,883 (EDAS+IMM) and US$20,968 (IMM) QALYs were 0.77 (EDAS+IMM) and 0.69 (IMM) (range 0-0.89 corresponding to death-baseline health). The cost per QALY gained after EDAS+IMM was US$68,916, and US$63,916 for IMM. The corresponding ICER for EDAS+IMM versus IMM was $65,736, below the threshold of US$189,153 (3xGPD-per-capita) for cost effectiveness.Conclusions:ARR of stroke/death of at least 3.4% after EDAS is a cost-effective strategy for the treatment of high-risk sICAD patients. This ARR is conservative compared to the observed 5.9% ARR in the ERSIAS-PC trial. Further investigation of EDAS in a pivotal/phase III trial is supported as a cost-effective strategy