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  • Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

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Ischemic stroke
Original research
Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective
  1. Osama O Zaidat1,
  2. Marc Ribo2,3,
  3. Heinrich Paul Mattle4,
  4. Jeffrey L Saver5,
  5. Hormozd Bozorgchami6,
  6. Albert J Yoo7,
  7. Alexandra Ehm8,
  8. Emilie Kottenmeier9,
  9. Heather L Cameron10,
  10. Rana A Qadeer10,
  11. Tommy Andersson11,12
  1. 1 Department of Neuroscience, Mercy Saint Vincent Medical Center, Toledo, Ohio, USA
  2. 2 Stroke Unit, Neurology, Hospital Vall d'Hebron, Barcelona, Spain
  3. 3 Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain
  4. 4 Department of Neurology, Inselspital, University of Bern, Bern, Switzerland
  5. 5 Department of Neurology, UCLA, Los Angeles, California, USA
  6. 6 Oregon Health and Science University, Portland, Oregon, USA
  7. 7 Department of Neurointervention, Texas Stroke Institute, Plano, Texas, USA
  8. 8 Johnson & Johnson Medical GmbH, Norderstedt, Germany
  9. 9 Cerenovus, Johnson & Johnson, Irvine, California, USA
  10. 10 EVERSANA, Burlington, Ontario, Canada
  11. 11 Departments of Radiology and Neurology, AZ Groeninge, Kortrijk, Belgium
  12. 12 Departments of Neuroradiology and Clinical Neuroscience, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Osama O Zaidat, Department of Neuroscience, Mercy Saint Vincent Medical Center, Toledo, OH 43608, USA; OOZaidat{at}Mercy.com

Abstract

Background First-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed.

Objective To assess the economic impact of achieving complete or near complete reperfusion after the first pass.

Methods Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c–3 was achieved, stratified into two groups: (1) mTICI 2c–3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK).

Results Among patients who achieved mTICI 2c–3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0–2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24–33% reduction) and annual care (11–27% reduction) costs across all countries.

Conclusions FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.

  • stroke
  • thrombectomy
  • economics

Data availability statement

No data are available.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/neurintsurg-2020-016930

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    Data availability statement

    No data are available.

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    Footnotes

    • Twitter @marcriboj

    • Contributors All authors made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work. Additionally, all authors were involved in drafting the work or revising it critically for important intellectual content and final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

    • Funding This study was funded by Cerenovus, a subsidiary of Johnson and Johnson.

    • Competing interests OOZ serves as a consultant for Neuravi, Stryker, Penumbra, and Medtronic. MR is a shareholder in Anaconda Biomed; consultant for Neuravi/Cerenovus, Medtronic, Stryker, Apta Targets, and Vesalio. HPM reports personal fees from Covidien/Medtronic, Neuravi/Cerenovus, Servier, and Bayer outside the submitted work; served on the steering committees of the SWIFT PRIME and ARISE studies. JLS is an employee of the University of California, which holds a patent on retriever devices for stroke. The University of California, Regents receives funding for the services of JLS as a scientific consultant regarding trial design and conduct to Covidien/Medtronic and Stryker; serves as a consultant for Modest, Abbott, Medtronic, Stryker, and Neuravi/Cerenovus; has contracted stock options for Modest and Rapid Medical. HB serves as a modest consultant for Neuravi/Cerenovus, and Stryker. AJY is a consultant for Cerenovus, Penumbra, Genentech, and Zoll Circulation; receives research grant support from Cerenovus, Penumbra, Medtronic, Stryker, and Genentech; and has equity interest in Insera Therapeutics. AE is an employee of Johnson and Johnson. EK is an employee of Cerenovus, a subsidiary of Johnson and Johnson. HLC and RAQ are paid consultants for Cerenovus. TA is a consultant for Neuravi/Cerenovus, Anaconda, Amnis Therapeutics, and Rapid Medical; served on the steering committees of the ARISE studies.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.