mechanical thrombectomy in acute ischemic stroke patients – including, but not limited to the NASA registry data. In the NASA registry clinical outcomes of mechanical thrombectomy with the Solitaire FR device (stent retriever) were comparable with results from the SWIFT and TREVO 2 RCTs. ‘Best practice’ HTA should consider evidence from different study designs. However, it is recognised that EUnetHTA conducted a rapid HTA, which may explain why evidence from non-randomised and observational studies was not considered.
Table 12 List of resources to be considered in the economic analysis Provider of resource Setting in which resource is provided Proportion of patients receiving resource Number of units of resource per relevant time horizon per patient receiving resource Disaggregated unit cost MBS (MBS item, fee) Safety nets* Other government budget Private health insurer Patient Total cost Resources provided to identify eligible population Brain imaging (e.g. CT, MRI) Private or Public Hospital Radiology clinic/department 100% CT: 56001 $195.05 MRI: 63064 $403.20 Brain and carotid imaging (e.g. CTA, MRA) Private or Public Hospital Radiology clinic/department 100% CTA: 57350 $510.00 MRA: 63101 $492.80 Routine investigations: e.g. full blood count, ECG, renal function Private or Public Hospital ED/stroke service 100% FBC: 65070 $16.95 ECG: 11700 $31.25 ED/stroke service clinician and nursing staff Private or Public Hospital ED/stroke service 100% Resources provided to deliver proposed intervention Mechanical thrombectomy devices and associated neurointerventional devices such as guidewires, microcatheters, and other access devices Private or Public Hospital Angiography suite or catheterization laboratory Variable (depends on clinical/technical contraindications) Mechanical thrombectomy procedure provision Practitioner Angiography suite or catheterization laboratory Variable (as above) Neuroimaging: e.g. fluoroscopy Private or Public Hospital Angiography suite or catheterization laboratory Variable (as above) eg. Item 60009c $1,376.30
Anaesthesia: Examples of the types of relevant MBS items include:: -Initiation of management of anaesthesia -Intra-arterial cannulation with anaesthesia b Anaesthetist Surgical Variable and whether service done under general anaesthesia or conscious sedation Examples: MBS 20210 $297.00 MBS 22025 $79.20 General consumables: e.g. dressings Private or Public Hospital Angiography suite or catheterization laboratory 100% Monitoring equipment: blood pressure, heart rate & oxygenation Private or Public Hospital Angiography suite or catheterization laboratory 100% BP b: 22012 $59.40 Hospitalisation for procedure (overnight stay) Private or Public Hospital Private or Public Hospital 100% Resources provided in association with proposed intervention Pre-intervention: Routine investigations: e.g. full blood count, ECG, renal function Private or Public Hospital ED/stroke service 100% FBC: 65070 $16.95 ECG: 11700 $31.25 Follow-up brain imaging Private or Public Hospital Angiography suite or catheterization laboratory 100% as an example: 60009 $1,376.30 Resources provided to deliver current clinical practice – that are also required for the intervention Drug therapy: IV tPA in eligible patients; anti-thrombotic Private or Public Hospital ED/stroke service Variable (determined by Variable IV tPA: Alteplase: TBA
therapy for IV tPA ineligible patients time or non time based contraindication to. IV tPA) (dose dependent on patient) Anti-thrombotic: aspirin Monitoring equipment: blood pressure, heart rate & oxygenation Private or Public Hospital Angiography suite or catheterization laboratory 100% BP b: 22012 $59.40 Resources provided in association with current clinical practice Pre-intervention: Routine investigations: e.g. full blood count, ECG, renal function. Private or Public Hospital ED/stroke service 100% FBC: 65070 $16.95 ECG: 11700 $31.25 Follow-up: brain imaging Private or Public Hospital Angiography suite or catheterization laboratory 100% Resources used to manage patients successfully treated with the proposed intervention. Resources required to manage patients (e.g. hospital stays, short- and long-term rehabilitation services, allied healthcare and carer services) will vary depending on patient degree of independence and disability that is achieved following the acute intervention phase of treatment. Diagnostic and pathology services. Depends on individual patient needs Management of AEs Private or Public Hospital Private or Public Hospital Varies Hospital stay - AR-DRG for stroke and other cerebrovascaular diseases d B70A: +CCC B70B: +SCC B70C: -CSCC Private or Public Hospital Private or Public Hospital Depends on individual patient needs $17,443 $9,766 $6,794
B70D: DIE/TRN<5D $3,599 Rehabilitation services Depends on individual patient needs Community based services (residential care; allied health; home nursing; carers; ambulance etc.) Depends on individual patient needs Resources used to manage patients who are unsuccessfully treated with the proposed intervention Resources required to manage patients (e.g. hospital stays, short- and long-term rehabilitation services, allied healthcare and carer services) will vary depending on patient degree of independence and disability that is achieved following the acute intervention phase of treatment. Diagnostic and pathology services Depends on individual patient needs Management of AEs Private or Public Hospital Private or Public Hospital Varies Hospital stay– AR-DRG B70A to B70D d Private or Public Hospital Private or Public Hospital Depends on individual patient needs $17,443 to $3,599 Rehabilitation services Depends on individual patient needs Community based services (residential care; allied health; home nursing; carers; ambulance etc.) Depends on individual patient needs Resources used to manage patients successfully treated with current clinical practice Resources required to manage patients (e.g. hospital stays, short- and long-term rehabilitation services, allied healthcare and carer services) will vary depending on patient degree of independence and disability that is achieved following the acute intervention phase of treatment. Diagnostic and pathology Depends on
services individual patient needs Hospital stay AR-DRG B70A to B70D d Private or Public Hospital Private or Public Hospital Depends on individual patient needs $17,443 to $3,599 Rehabilitation services Depends on individual patient needs Community based services (residential care; allied health; home nursing; carers; ambulance etc.) Depends on individual patient needs Resources used to manage patients who are unsuccessfully treated with current clinical practice Resources required to manage patients (e.g. hospital stays, short- and long-term rehabilitation services, allied healthcare and carer services) will vary depending on patient degree of independence and disability that is achieved following the acute intervention phase of treatment. Diagnostic and pathology services Depends on individual patient needs Hospital stay AR-DRG B70A to B70D d Private or Public Hospital Private or Public Hospital Depends on individual patient needs $17,443 to $3,599