Background and purpose Early Reperfusion is critical for favourable outcomes in ischaemic stroke (AIS). Stent-Retrievers lead to faster and more complete reperfusion than previous technologies. Our aim is to compare the cost-effectiveness of Stent-Retrievers (the Solitaire™ FR device and the Trevo™ Pro Retrieval System) to the previous mechanical thrombectomy devices.
Methods Retrospective review of a prospective collected database of endovascularly treated large vessel AIS in a large academic centre. Data from all consecutive patients who underwent treatment with Merci, Penumbra, intracranial stenting, or Stent-Retrievers from January 2012 through November 2012 were analysed. Baseline characteristics including age, gender, baseline NIHSS, and co-morbidities were analysed. The primary outcomes measures was the total procedural cost (using device list price). Other outcome measures included the rates of successful near-complete or complete recanalisation (TICI 2b-3) and good outcomes (90-day mRS 0–2) as well as the length of stay at the hospital, and the critical care unit. Univariate analysis was performed to identify any differences between the Stent-Retriever (SR) and the Non Stent-Retriever (NSR) groups. Logistic regression analysis was performed to define factors associated with a “high cost procedure” (defined as a cost above the median procedural cost for the overall cohort).
Results After excluding the patients that underwent concomitant extra-cranial stenting (n=22) or received Intra-Arterial t-PA only (n=6), the entire cohort included 150 patients. There were no significant differences in terms of baseline characteristics between the SR group (n= 85) and the NSR group (n=65). The total cost of the reperfusion procedure was significantly higher in the SR group compared to the NSR ($13,419 vs $9,308, p <0.001). We were unable to demonstrate a statistical significant difference in the rates of TICI 2b-3 reperfusion (81 % vs 74% respectively, p= 0.337) or the length of stay (11.1 ± 9.1 days vs 12.8 ± 9.6 days respectively, p=0.260) amongst the SR and the NSR patients./ Notably, the devices procedural cost alone for the SR and NSR treatments comprised 44% and 31% of the national mechanical thrombectomy DRG (MS-DRG 024 = $30,197), respectively.
Conclusion The procedural costs of mechanical thrombectomy for AIS are increasing and account for the bulk of hospitalisation reimbursement. The impact of these expenditures in the long-term sustainability of stroke centres deserves greater consideration. While is likely that the SR technology results in higher rates of optimal reperfusion, better clinical outcomes, and shorter lengths of stay, larger studies are needed to prove its cost-effectiveness.
Disclosures T. Kass-Hout: None. O. Kass-Hout: None. C. Sun: None. R. Gupta: None. R. Nogueira: None.
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