Kossar Hosseini

Cost-Effectiveness of Thrombectomy in Patients With Acute Ischemic Stroke: The THRACE Randomized Controlled Trial

Background and Purpose— The benefit of mechanical thrombectomy added to intravenous thrombolysis (IVT) in patients with acute ischemic stroke has been largely demonstrated. However, evidence of the economic incentive of this strategy is still limited, especially in the context of a randomized controlled trial. We aimed to analyze whether mechanical thrombectomy combined with IVT (IVMT) is cost-effective when compared with IVT alone. Methods— Individual-level cost and outcome data were collected in the THRACE randomized controlled trial (Thrombectomie des Artères Cerébrales) including patients with acute ischemic stroke. Patients were assigned to receive IVT or IVMT. The primary outcomes were modified Rankin Scale score of functional independence at 90 days (score 0–2) and the EuroQol-5D quality-of-life score at 1 year. Results— Treating acute ischemic stroke with IVMT (n=200) versus IVT (n=202) increased the rate of functional independence by 10.9% (53.0% versus 42.1%; P=0.028), at an increased cost of

Target organ damage assessment in French hypertensive patients without established cardiovascular or renal disease: results of the PREVENT-A study.

2116 (&OV0556;1909), with no significant difference in mortality (12% versus 13%; P=0.70) or symptomatic intracranial hemorrhage (2% versus 2%; P=0.71). The cost per one averted case of disability was estimated at

THU0432 Impact of Comorbidities on Measuring Indirect Utility by the SF-6D or the EQ-5D in Rheumatoid Arthritis: an Analysis of 962 Patients Enrolled in Comedra

19 379 (&OV0556;17 480). The incremental cost per one quality-adjusted life year gained was

Impact of co-morbidities on measuring indirect utility by the Medical Outcomes Study Short Form 6D in lower-limb osteoarthritis

14 881 (&OV0556;13 423). On sensitivity analysis, the probability of cost-effectiveness with IVMT was 84.1% in terms of cases of averted disability and 92.2% in terms of quality-adjusted life years. Conclusions— Based on randomized trial data, this study demonstrates that IVMT used to treat acute ischemic stroke is cost-effective when compared with IVT alone. Clinical Trial Registration— URL: http://www.clinicaltrials.gov. Unique identifier: NCT01062698.

Cost-Effectiveness of Thrombectomy in Patients With Acute Ischemic Stroke

Objectives: To evaluate the modalities of subclinical target organ damage (TOD) assessment in France, 2–3 years after publication of the European Society of Hypertension (ESH)/European Society of Cardiology (ESC) 2007 guidelines. Methods: Two parallel, large, cross-sectional surveys were performed in representative samples of 516 private practice cardiologists, and 943 general practitioners (GPs), in hypertensive patients (952 and 1778, respectively) without established cardiovascular or renal disease. Results: At least one TOD search was performed in 97.6% of cardiologists’ patients, performed or ongoing in 96.1% of GPs’ patients, with a median number of three TOD searches in both surveys. Only 8.6% of cardiologists’ patients and 6.3% of GPs’ patients had a full set of TOD analyses [i.e. the five categories investigated: left ventricular hypertrophy (LVH), vascular, renal, retinopathy and cerebrovascular]. When considering the three priority categories of subclinical TOD search recommended by the ESH/ESC guidelines (i.e. LVH, vascular and renal), 63.2% of cardiologists’ patients and 49.5% of GPs’ patients had this triple assessment completed. The new TOD assessment modalities, namely pulse wave velocity, ankle brachial index and microalbuminuria, were rarely used. Only 3.3% of GPs’ patients and 15.4% of cardiologists’ patients were reclassified with an upgraded cardiovascular risk. Conclusion: Subclinical TOD modalities are commonly assessed in French hypertensive patients without established cardiovascular or renal diseases, although 55% still do not benefit from combined triple LVH, macrovascular and renal assessment. The new modalities of TOD assessment are rarely implemented. Moreover, TOD assessment displayed poor effectiveness in upgrading cardiovascular risk classification.

Iconography : Évaluation médico-économique de l’apport de la thrombectomie en phase aiguë d’un accident ischémique cérébral « Étude THRACE »

Background Many patients with rheumatoid arthritis (RA) have several chronic co-occuring disorders (comorbidities). There is an inverse relationship between comorbidy and health-related quality of life (HRQoL). Because indirect utility measurement involves HRQoL, comorbidities probably affect utility assessment. Objectives We investigated the impact of comorbidities on the measure of utility with 2 indirect utility measures widely used to calculate quality-adjusted life-years (QALYs), SF-6D and EQ-5D, in patients with rheumatoid arthritis (RA). Methods 962 patients of COMEDRA, a French multicentric clinical trial involving patients with stable RA, were included in the study. Comorbidities assessed were chronic obstructive pulmonary disease, diabetes, hypertension, obesity, cardio-vascular diseases, stroke, hypercholesterolemia, renal insufficiency and osteoporosis. Bio-clinical variables were also recorded (activity by DAS28, function by HAQ score, Rheumatoid Arthritis Impact of Disease score ...). Two separate linear regression models, using the number of comorbidities and the different categories of comorbidities, were fitted to determine predictors of utility scores. Results For the 962 patients included (mean age ± SD =57.7±11.1 years, 79% women), the mean SF-6D utility score was 0.67±0.12 (range: 0.357, 1), and the mean EQ-5D utility score was 0.64±0.27 (range: -0.416, 1). The mean number of comorbidities was 1.02±0.95 and 40.6% of patients have 1 comorbidity, 19.3%, 2 comorbidities and 7%, ≥3 comorbidities. In the first multivariate model, for each additional comorbidity (range 0–5) the mean SF-6D utility score decreased of 0.007 point (p<0.0001) and the mean EQ-5D utility score decreased of 0.028 point (p<0.0001). In the second model, including comorbidities by categories, no comorbidity predicted significantly low utility score. In both regression models a worsened function (increased HAQ score) significantly decreased the EQ-5D utility score and a worsened mental state (increased mental component of RAID score) significantly decreased the SF-6D utility score. The number of comorbidities explained <1% of the variance in utility scores (partial R-square=0.0097 for EQ-5D and 0.003 for SF-6D), whereas the HAQ score explained 51.2% of the variance in EQ-5D utility score in both models and the mental state explained 38,2% of the variance in SF-6D utility score. Conclusions Compared to greater negative effect of functional impairment for EQ-5D and mental state for SF-6D, the number of comorbidities has a negative but relatively marginal impact on indirect utility scores in RA. Disclosure of Interest : None declared DOI 10.1136/annrheumdis-2014-eular.5794

The Minimal Important Decrease of Health Utility in Living Kidney Donors

INTRODUCTION Co-morbidities can influence generic measurement of health indirect utility. We investigated their impact to assess indirect utility with the Medical Outcomes Study Short Form 6D (SF-6D) in patients with osteoarthritis (OA). METHODS In patients with hip and knee OA from the Knee and Hip Osteo-Arthritis Long-term Assessment (KHOALA) study, co-morbidities were assessed by the Functional Co-morbidity Index. Multivariate linear regressions were used to determine predictors of utility score. RESULTS For the 878 patients included, the mean (standard deviation (SD)) utility score for 808 patients was 0.66 (11; range 0.32-1.00) and mean number of co-morbidities 2.05 (1.58). Number of co-morbidities (beta = -0.30; p = 0.002), psychiatric disease (beta = -0.043; p < 0.0001) and degenerative disc disease (beta = -0.014; p = 0.018) were predictors of low utility score. The WOMAC functional score had a higher significant effect (beta = -0.003; p < 0.0001) and explained a higher percentage of the model variance. DISCUSSION Compared to greater negative effect of functional severity of OA, co-morbidities have a negative but relatively marginal impact on indirect utility score. This suggests that, clinically, considering the functional severity of OA remains a first priority.