• Henk van Voorst, Jan W Hoving, Miou S Koopman, Jasper D Daems, Daan Peerlings, Erik Buskens, Hester Lingsma, Henk A Marquering, de JongHugo W A MHWAMUMC Utrecht, Utrecht, Utrecht, The Netherlands., Olvert A Berkhemer, Wim H van Zwam, van WalderveenMarianne A AMAALeids Universitair Medisch Centrum, Leiden, Zuid-Holland, The Netherlands., Ido R van den Wijngaard, DippelDiederik W JDWJ0000-0002-9234-3515Neurology, Erasmus Mc University Medical Center, Rotterdam, The Netherlands., Albert J Yoo, Bruce Campbell, Wolfgang G Kunz, Charles B Majoie, Bart J Emmer, CLEOPATRA, MR CLEAN Registry, and CONTRAST Consortium Investigators.
• Department of Radiology and Nuclear Medicine, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands h.vanvoorst@amsterdamumc.nl.
• J. Neurol. Neurosurg. Psychiatr. 2024 May 14; 95 (6): 515527515-527.

BackgroundAlthough CT perfusion (CTP) is often incorporated in acute stroke workflows, it remains largely unclear what the associated costs and health implications are in the long run of CTP-based patient selection for endovascular treatment (EVT) in patients presenting within 6 hours after symptom onset with a large vessel occlusion.MethodsPatients with a large vessel occlusion were included from a Dutch nationwide cohort (n=703) if CTP imaging was performed before EVT within 6 hours after stroke onset. Simulated cost and health effects during 5 and 10 years follow-up were compared between CTP based patient selection for EVT and providing EVT to all patients. Outcome measures were the net monetary benefit at a willingness-to-pay of €80 000 per quality-adjusted life year, incremental cost-effectiveness ratio), difference in costs from a healthcare payer perspective (ΔCosts) and quality-adjusted life years (ΔQALY) per 1000 patients for 1000 model iterations as outcomes.ResultsCompared with treating all patients, CTP-based selection for EVT at the optimised ischaemic core volume (ICV≥110 mL) or core-penumbra mismatch ratio (MMR≤1.4) thresholds resulted in losses of health (median ΔQALYs for ICV≥110 mL: -3.3 (IQR: -5.9 to -1.1), for MMR≤1.4: 0.0 (IQR: -1.3 to 0.0)) with median ΔCosts for ICV≥110 mL of -€348 966 (IQR: -€712 406 to -€51 158) and for MMR≤1.4 of €266 513 (IQR: €229 403 to €380 110)) per 1000 patients. Sensitivity analyses did not yield any scenarios for CTP-based selection of patients for EVT that were cost-effective for improving health, including patients aged ≥80 years CONCLUSION: In EVT-eligible patients presenting within 6 hours after symptom onset, excluding patients based on CTP parameters was not cost-effective and could potentially harm patients.© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.

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