Introduction

In 2019, according to Global Burden of Disease Study estimates, there were 12.2 million incident cases of stroke; stroke remained the second leading cause of death globally, accounting for 11.6% of total deaths, and was the third leading cause of death and disability combined.1 In addition, stroke has significant economic impacts. The global burden of stroke was estimated to be US$891 billion in 2017.2 In the United States, the mean lifetime cost of stroke has been estimated to be US$140048.3 Strokes are also associated with a considerable financial burden in lower- and middle-income countries, with the average direct costs of stroke care estimated to be US$8424 in Nigeria, US$5230 in Pakistan, and US$3626 in China.4 Accordingly, novel cost-reduction strategies for stroke care might have a particularly substantial effect in lower- and middle-income countries, where resources are constrained.

Mechanical thrombectomy is the standard of care for anterior circulation large vessel occlusions and is increasingly used for posterior circulation large vessel occlusions.5 6 To ameliorate the costs of this procedure, manufacturer-driven bundling programs have been developed in which all of the necessary devices are purchased together, as opposed to each device being purchased individually (ie, à la carte).7 These programs were previously shown to be cost-effective for stroke care in a study by Munich et al that demonstrated an average savings per case of US$2900.93.7

Because only one previous study has demonstrated the effect of bundling programs on the cost for stroke care, there is a need for further investigation of this topic. Therefore, we performed a retrospective chart review to assess the efficacy of bundling costs for instruments used in mechanical thrombectomy at a high-volume stroke center.