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Abstract
Background Evidence has shown that endovascular thrombectomy (EVT) treatment improves clinical outcomes. Yet, its benefit remains uncertain in patients with large established infarcts as defined by ASPECTS (Alberta Stroke Program Early CT Score) <6. This study evaluates the cost-effectiveness of EVT, compared with standard care (SC), in acute ischemic stroke (AIS) patients with ASPECTS 3–5.
Methods An economic evaluation study was performed combining a decision tree and Markov model to estimate lifetime costs (2021 US$) and quality-adjusted life years (QALYs) of AIS patients with ASPECTS 3–5. Incremental cost-effectiveness ratios (ICERs), net monetary benefits (NMBs), and deterministic one-way and two-way sensitivity analyses were performed. Probabilistic sensitivity analyses were also performed to evaluate the robustness of our model.
Results Compared with SC, the cost-effectiveness analyses revealed that EVT yields higher lifetime benefits (2.20 QALYs vs 1.41 QALYs) with higher lifetime healthcare cost per patient ($285 861 vs $272 954). The difference in health benefits between EVT and SC was 0.79 QALYs, equivalent to 288 additional days of healthy life per patient. Even though EVT is more costly than SC alone, it is still cost-effective given better outcomes with ICER of $16 239/QALY. The probabilistic sensitivity analyses indicated that EVT was the most cost-effective strategy in 98.8% (9882 of 10 000) of iterations at the willingness-to-pay threshold of $100 000 per QALY.
Conclusions The results of this study suggest that EVT is cost-effective in AIS patients with a large ischemic core (ASPECTS 3–5), compared with SC alone over the patient’s lifetime.
- economics
- stroke
- thrombectomy
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
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Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information.
Footnotes
Twitter @AjayMalhotraRad
Contributors MXS collected the data, performed the literature search, designed and analyzed the decision analysis model, analyzed and interpreted the results, revised the manuscript for important intellectual content, and drafted and edited the final version. JMK oversaw the integrity of the entire study, designed and analyzed the decision analysis model, reviewed the results, revised the manuscript for important intellectual content, and drafted and edited the final version. JW, KS and MB designed and analyzed the decision analysis model, reviewed the results, revised the manuscript for important intellectual content, and edited the final version. AM oversaw the integrity of the entire study, designed and analyzed the decision analysis model, reviewed the results, revised the manuscript for important intellectual content, and edited the final version. GM performed the literature search, designed and analyzed the decision analysis model, analyzed and interpreted the results, revised the manuscript for important intellectual content, and edited the final version. PCS oversaw the integrity of the entire study, supervised data collection, designed and analyzed the decision analysis model, analyzed and interpreted the results, revised the manuscript for important intellectual content, and drafted and edited the final version.
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 MXS and KS hold a Visiting Scholar appointment at the Feinstein Institutes for Medical Research in the Center for Health Innovations and Outcomes Research and are employees of Siemens Medical Solutions USA Inc. MXS and KS are shareholders of Siemens Healthineers. JMK, JW and PCS receive research support from Siemens Healthineers.
Provenance and peer review Not commissioned; externally peer reviewed.
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