Introduction Clinical equipoise exists behind bridging intravenous thrombolysis (BT) with endovascular thrombectomy (EVT).

Aim of Study To compare the cost-effectiveness of EVT alone vs. BT in acute ischemic stroke (AIS)

Methods We conducted a model-based cost-utility analysis comparing the cost-effectiveness of EVT alone vs. BT in AIS. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. We considered the impact of disability and recurrent stroke on mortality risk, health-related quality of life, and costs. We estimated total and incremental cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER), expressed as an incremental cost per QALY gained of BT compared with EVT alone. Probabilistic analysis was used to calculate the reference case estimates.

Results The average costs per patient were estimated to be $55,503, $57,814, $68,183, and $84,946 for BT, and $47,311, $49,556, $59,625, and $75,898 for EVT only over 90-day, 1-year, 5-year, and 20-year, respectively. The cost saving of EVT only strategy was driven by the avoided medication costs of IVT (ranging from $8,193 to $9,048). The additional thrombolytics led to slight decrease in QALY estimate during the 90-day time horizon (loss of 0.0016 QALY), but a small gain over 1-year, 5-year, and 20-year time horizons (0.0108, 0.0638, and 0.1481 QALY). With similar outcomes and less cost, the EVT only strategy was cost-effective compared with BT.

Conclusion Our cost-effectiveness model suggests bridging with thrombolytics may not be cost-effective in AIS secondary to large vessel occlusion.

Disclosure of Interest The authors have nothing to disclose.