Supplementary materials: The economic impact associated with stent retriever selection for the treatment of acute ischemic stroke: a cost-effectiveness analysis of MASTRO I data from a Chinese healthcare system perspective

<b>These are peer-reviewed supplementary materials for the article '</b><b>The economic impact associated with stent </b><b>retriever selection for the treatment of </b><b>acute ischemic stroke: a cost-effectiveness </b><b>analysis of MASTRO I data from a Chinese </b><b>healthcare system perspectiv</b>e<b>' published in the</b><b> </b><b><i>Journal of Comparative Effectiveness Research</i></b><b>.</b><b>Supplementary Table 1:</b> Transition probabilities<b>Supplementary Table 2: </b>Cost and Utility Model Inputs<b>Supplementary Table 3: </b>ICERs Associated with Varying Cost of Solitaire and Trevo<b>Supplementary Figure 1: </b>Tornado Diagram for the Pairwise Deterministic One-Way Sensitivity Analysis of EmboTrap Versus Solitaire<b>Supplementary Figure 2: </b>Tornado Diagram for the Pairwise Deterministic One-Way Sensitivity Analysis of Trevo Versus EmboTrap<b>Supplementary Figure 3: </b>Tornado Diagram for the Pairwise Deterministic One-Way Sensitivity Analysis of Trevo Versus Solitaire<b>Supplementary Figure 4: </b>ICERs Associated with Varying Cost of (A) Solitaire and (B) Trevo<b>Aim:</b> The aim of this analysis was to assess the cost-effectiveness of the EmboTrap R ? Revascularization Device compared with the Solitaire™ Revascularization Device and Trevo R ? Retriever for the treatment of acute ischemic stroke (AIS) from the perspective of the Chinese healthcare system. <b>Methods:</b> According to MASTRO I, a recent living systematic literature review and meta-analysis, mechanical thrombectomy (MT) with EmboTrap in the treatment of AIS resulted in better functional outcomes compared with the use of Solitaire or Trevo. Based on the proportion of patients that achieved 90-day modified Rankin Scale (mRS) scores of 0-2, 3-5 and 6 reported in MASTRO I, a combined 90-day short-term decision tree and Markov model with a 10-year time horizon was used to compare the cost-effectiveness of the three devices. The primary outcome was the incremental cost-effectiveness ratio (ICER), representing the incremental cost (in 2022 Chinese Yuan [CNY]) per incremental quality-adjusted life-year (QALY). The ICERs were compared against willingness-to-pay (WTP) thresholds of 1, 1.5 and 3-times the 2022 national gross domestic product (GDP) per capita in China. <b>Results: </b>Treatment with EmboTrap resulted in total QALYs of 3.28 and total costs of 110,058 CNY per patient. Treatment with Trevo resulted in total QALYs of 3.05 and total costs of 116,941 CNY per patient. Treatment with Solitaire resulted in total QALYs of 2.81 and total costs of 99,090 CNY per patient. Trevo was dominated by EmboTrap as it was a more costly and less effective intervention. As such, Trevo was not cost-effective at any WTP threshold. Compared with Solitaire, EmboTrap was more effective and more costly, with an ICER of 23,615 CNY per QALY. This result suggests that EmboTrap is cost-effective when compared with Solitaire since the ICER was lower than all WTP thresholds assessed. <b>Conclusion:</b> EmboTrap dominated Trevo and is cost-effective for the treatment of patients with AIS compared with Solitaire when assessed from the perspective of the Chinese healthcare system and based on the devicelevel meta-analysis MASTRO I. Selecting a stent retriever (SR) that optimizes 90-day mRS score is an important consideration from both a clinical and healthcare payer perspective in China as it is associated with reduced long-term costs and increased quality of life.

本数据集为发表于《Journal of Comparative Effectiveness Research》的论文《急性缺血性卒中取栓支架选择的经济学影响：基于中国医疗卫生体系视角的MASTRO I研究数据成本效果分析》的同行评议补充材料。
补充表1：转移概率
补充表2：成本与效用模型输入参数
补充表3：不同Solitaire与Trevo成本下的增量成本效果比（incremental cost-effectiveness ratio, ICER）
补充图1：EmboTrap对比Solitaire的配对确定性单因素敏感性分析龙卷风图
补充图2：Trevo对比EmboTrap的配对确定性单因素敏感性分析龙卷风图
补充图3：Trevo对比Solitaire的配对确定性单因素敏感性分析龙卷风图
补充图4：不同（A）Solitaire与（B）Trevo成本下的增量成本效果比（ICER）

研究目的：本分析旨在从中国医疗卫生体系视角出发，评估EmboTrap®血管重建装置、Solitaire™血管重建装置与Trevo®取栓支架治疗急性缺血性卒中（acute ischemic stroke, AIS）的成本效果性。

研究方法：依据最新的动态系统综述与Meta分析MASTRO I研究，与使用Solitaire或Trevo相比，采用EmboTrap进行机械取栓（mechanical thrombectomy, MT）治疗急性缺血性卒中可获得更优的功能结局。基于MASTRO I研究中报告的患者90天改良Rankin量表（modified Rankin Scale, mRS）评分分布为0~2分、3~5分及6分的比例，本研究采用结合90天短期决策树与10年时间跨度的马尔可夫（Markov model）模型，对比三种取栓装置的成本效果性。本研究的主要结局指标为增量成本效果比（incremental cost-effectiveness ratio, ICER），即每获得1个增量质量调整生命年（quality-adjusted life-year, QALY）所需的增量成本（单位：2022年人民币[CNY]）。将ICER与中国2022年人均国内生产总值（gross domestic product, GDP）的1倍、1.5倍及3倍的支付意愿（willingness-to-pay, WTP）阈值进行对比。

研究结果：每例患者采用EmboTrap治疗的总质量调整生命年（QALY）为3.28，总治疗成本为110058元人民币；采用Trevo治疗的总QALY为3.05，总治疗成本为116941元人民币；采用Solitaire治疗的总QALY为2.81，总治疗成本为99090元人民币。Trevo因成本更高且疗效更劣，被EmboTrap所主导，因此在任何支付意愿（WTP）阈值下均不具备成本效果性。与Solitaire相比，EmboTrap疗效更优但成本更高，每QALY的ICER为23615元人民币。由于该ICER低于所有评估的WTP阈值，提示与Solitaire相比，EmboTrap具备成本效果性。

研究结论：基于MASTRO I的设备层面Meta分析，从中国医疗卫生体系视角评估时，EmboTrap可主导Trevo，且与Solitaire相比，其用于急性缺血性卒中患者治疗具备成本效果性。在中国，从临床与医疗支付方视角出发，选择可优化90天mRS评分的取栓支架（stent retriever, SR）是一项重要考量因素，因为这类支架可降低长期治疗成本并提升患者生存质量。