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

These are peer-reviewed supplementary materials for the article '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' published in the Journal of Comparative Effectiveness Research.Supplementary Table 1: Transition probabilitiesSupplementary Table 2: Cost and Utility Model InputsSupplementary Table 3: ICERs Associated with Varying Cost of Solitaire and TrevoSupplementary Figure 1: Tornado Diagram for the Pairwise Deterministic One-Way Sensitivity Analysis of EmboTrap Versus SolitaireSupplementary Figure 2: Tornado Diagram for the Pairwise Deterministic One-Way Sensitivity Analysis of Trevo Versus EmboTrapSupplementary Figure 3: Tornado Diagram for the Pairwise Deterministic One-Way Sensitivity Analysis of Trevo Versus SolitaireSupplementary Figure 4: ICERs Associated with Varying Cost of (A) Solitaire and (B) TrevoAim: 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. Methods: 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. Results: 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. Conclusion: 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《比较疗效研究杂志》之文章《关于急性缺血性卒中（AIS）治疗中支架取栓器选择的经济学影响：从中国医疗保障体系视角进行的成本效益分析——MASTRO I数据》的同行评审补充材料。补充表1：转换概率表；补充表2：成本与效用模型输入；补充表3：与索利泰和特雷沃不同成本相关的增量成本效果比（ICER）；补充图1：EmboTrap与索利泰的成对确定性单因素敏感性分析的旋风图；补充图2：特雷沃与EmboTrap的成对确定性单因素敏感性分析的旋风图；补充图3：特雷沃与索利泰的成对确定性单因素敏感性分析的旋风图；补充图4：与（A）索利泰和（B）特雷沃不同成本相关的ICER。研究目的：本分析的目的是评估EmboTrap R血管再通装置相较于索利泰™血管再通装置和特雷沃R取栓器在治疗急性缺血性卒中（AIS）方面的成本效益，从中国医疗保障体系的视角进行分析。研究方法：根据MASTRO I，一项近期进行的活态系统文献综述和荟萃分析，使用EmboTrap进行机械取栓（MT）治疗AIS相比于使用索利泰或特雷沃，能带来更好的功能预后。基于MASTRO I中报告的达到90天改良Rankin量表（mRS）评分0-2、3-5和6的患者比例，采用一个包含90天短期决策树和具有10年时间跨度的马尔可夫模型，对比三种装置的成本效益。主要结果指标为增量成本效果比（ICER），表示每增加一个增量质量调整生命年（QALY）的增量成本（以2022年中国元[CNY]计算）。ICER与1、1.5和3倍于2022年中国人均国内生产总值（GDP）的支付意愿（WTP）阈值进行比较。研究结果：使用EmboTrap治疗的患者总QALY为3.28，总成本为每患者110,058元。使用特雷沃治疗的患者总QALY为3.05，总成本为每患者116,941元。使用索利泰治疗的患者总QALY为2.81，总成本为每患者99,090元。由于特雷沃的成本更高且效果更差，因此被EmboTrap所支配。因此，在所有支付意愿阈值下，特雷沃均不具备成本效益。与索利泰相比，EmboTrap更有效且成本更高，其ICER为每QALY 23,615元。这一结果表明，与索利泰相比，EmboTrap的成本效益更高，因为其ICER低于所有评估的支付意愿阈值。研究结论：从中国医疗保障体系的视角，基于设备层面的荟萃分析MASTRO I，EmboTrap在治疗AIS患者方面优于特雷沃，且具有成本效益。从临床和医疗保健付费方的角度出发，在中国选择一种能够优化90天mRS评分的支架取栓器（SR）是一项重要的考虑因素，因为它与降低长期成本和提高生活质量相关。