Cost-Effectiveness of Thrombectomy

Study Questions:

What is the cost-effectiveness of stent retriever–based thrombectomy in acute ischemic stroke?

Methods:

The authors compared the cost-effectiveness of intravenous tissue-type plasminogen activator alone versus mechanical thrombectomy and intravenous tissue-type plasminogen activator as a bridging therapy in eligible patients in the United Kingdom National Health Service. They developed a Markov model populated with probabilities, outcomes, and cost data from published sources.

Results:

Mechanical thrombectomy was more expensive than intravenous tissue-type plasminogen activator, but significantly improved quality-adjusted life expectancy. The incremental cost per quality-adjusted life-year gained with mechanical thrombectomy over a 20-year period was $11,651 (£7061). In a probabilistic sensitivity analysis, thrombectomy had a 100% probability of being cost-effective based on criteria commonly used in United Kingdom.

Conclusions:

The authors concluded that thrombectomy is a cost-effective strategy for treatment of stroke.

Perspective:

Stent retrievers have been demonstrated to be remarkably effective for treatment of stroke, and result in a clinically relevant reduction in disability. This study demonstrates that these therapies are also highly cost-effective. Quality efforts are needed to develop systems of care so that this therapy can be provided to stroke patients in a safe and rapid fashion.

Clinical Topics: Cardiac Surgery, Clinical Topic Collection: Dyslipidemia, Invasive Cardiovascular Angiography and Intervention, Lipid Metabolism

Keywords: Cost-Benefit Analysis, Quality-Adjusted Life Years, Stents, Stroke, Thrombectomy, Tissue Plasminogen Activator


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