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Ischemic Stroke
Original research
Implications of achieving TICI 2b vs TICI 3 reperfusion in patients with ischemic stroke: a cost-effectiveness analysis
  1. Xiao Wu1,
  2. Mihir Khunte1,
  3. Dheeraj Gandhi2,
  4. Charles Matouk3,
  5. Danny R Hughes4,
  6. Pina Sanelli5,
  7. Ajay Malhotra1
  1. 1 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 Interventional Neuroradiology, University of Maryland, Baltimore, Maryland, USA
  3. 3 Neurosurgery, Yale University, New Haven, Connecticut, USA
  4. 4 Harvey L Neiman Health Policy Institute, Reston, Virginia, USA
  5. 5 Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
  1. Correspondence to Dr Ajay Malhotra, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06510, USA; ajay.malhotra{at}yale.edu

Abstract

Background The benefit of endovascular thrombectomy (EVT) in stroke patients with large-vessel occlusion (LVO) depends on the degree of recanalization achieved. We aimed to determine the health outcomes and cost implications of achieving TICI 2b vs TICI 3 reperfusion in acute stroke patients with LVO.

Methods A decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years (QALY) of EVT-treated patients, and costs based on the degree of reperfusion achieved. The study was performed with a societal perspective in the United States' setting. The base case calculations were performed in three age groups: 55-, 65-, and 75-year-old patients.

Results Within 90 days, achieving TICI 3 resulted in a cost saving of $3676 per patient and health benefit of 11 days in perfect health as compared with TICI 2b. In the long term, for the three age groups, achieving TICI 3 resulted in cost savings of $46,498, $25,832, and $15 719 respectively, and health benefits of 2.14 QALYs, 1.71 QALYs, and 1.23 QALYs. Every 1% increase in TICI 3 in 55-year-old patients nationwide resulted in a cost saving of $3.4 million and a health benefit of 156 QALYs. Among 65-year-old patients, the corresponding cost savings and health benefit were $1.9 million and 125 QALYs.

Conclusion There are substantial cost and health implications in achieving complete vs incomplete reperfusion after EVT. Our study provides a framework to assess the cost-benefit analysis of emerging diagnostic and therapeutic techniques that might improve patient selection, and increase the chances of achieving complete reperfusion.

  • thrombectomy
  • stroke
  • economics

https://doi.org/10.1136/neurintsurg-2020-015873

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    Footnotes

    • Twitter @AjayMalhotraRad

    • Contributors AM: study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, study supervision. XW: study design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, study supervision. MK: acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. DG: acquisition of data, critical revision of the manuscript for important intellectual content, study supervision. CM: critical revision of the manuscript for important intellectual content, study supervision. DH: critical revision of the manuscript for important intellectual content. PS: acquisition of data, critical revision of the manuscript for important intellectual content, study supervision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information.