• Economics
• Political
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Health economic research, and particularly cost-effectiveness studies, are gaining increasing importance in medicine, and neurointervention is no exception. In light of rapidly increasing healthcare expenditure in almost every country, cost-effectiveness evaluations have become an important factor for policy decisions on healthcare use and adoption/reimbursement of new treatments. Specifically, politicians, policy makers, and third-party payers have to balance expenditure for neurointerventional treatments with expenditure in other sectors of healthcare, such as cancer treatments or preventive medicine.

For a treatment to become accepted as standard of care, we have to ask ourselves: ‘Does this treatment work?’, ‘How much health benefit do we get for our money?’, and ‘How does this compare with other treatments?’ This is the yardstick by which neurointerventional studies will be measured in the future. After efficacy studies have shown that the neurointerventional treatment works in the ideal setting, then effectiveness and cost-effectiveness studies need to demonstrate the health benefit in the real-world setting.

Indeed, the number of published cost-effectiveness analyses has steeply increased in the last few years. A scoping literature search on Pubmed/Medline using the search terms ‘thrombectomy’ or ‘coil’ or ‘embolization’ or ‘neurovascular’ or ‘neurointervention’ and ‘cost’ and ‘effectiveness’ yielded 58 relevant results, with a steep increase in publications since 2015. Most studies (n=44) investigated cost-effectiveness of mechanical stroke thrombectomy and endovascular aneurysm treatment (n=8). Cost-effectiveness analyses have been used to prove health economic benefit of a wide variety of neurointerventional treatments in different settings—for example, intravenous alteplase treatment for acute ischemic stroke in China,1 endovascular thrombectomy for acute ischemic stroke with large baseline infarcts in several European countries2 and North America,3 direct-to-angio stroke workflow paradigms in Spain,4 and coiling for aneurysmal subarachnoid hemorrhage in Thailand.5 Given the increasing importance of health economic assessments, it is crucial for neurointerventionalists to understand …