RT Journal Article SR Electronic T1 Endovascular thrombectomy in patients with large core ischemic stroke: a cost-effectiveness analysis from the SELECT study JF Journal of NeuroInterventional Surgery JO J NeuroIntervent Surg FD BMJ Publishing Group Ltd. SP 875 OP 882 DO 10.1136/neurintsurg-2020-016766 VO 13 IS 10 A1 Amrou Sarraj A1 Elena Pizzo A1 Kyriakos Lobotesis A1 James C Grotta A1 Ameer E Hassan A1 Michael G Abraham A1 Spiros Blackburn A1 Arthur L Day A1 Mark J Dannenbaum A1 William Hicks A1 Nirav A Vora A1 Ronald F Budzik A1 Anjail Z Sharrief A1 Sheryl Martin-Schild A1 Clark W Sitton A1 Deep Kiritbhai Pujara A1 Maarten G Lansberg A1 Rishi Gupta A1 Gregory W Albers A1 Wolfgang G Kunz A1 , YR 2021 UL http://jnis.bmj.com/content/13/10/875.abstract AB Background It is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.Methods In the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as computed tomography (CT) ASPECTS<6 or computed tomography perfusion (CTP) ischemic core volume (rCBF<30%) ≥50 cc. A Markov model estimated costs, quality-adjusted life years (QALYs) and the incremental cost-effectiveness ratio (ICER) of EVT compared with medical management (MM) over lifetime. The willingness to pay (WTP) per QALY was set at $50 000 and $100 000 and the net monetary benefits (NMB) were calculated. Probabilistic sensitivity analysis (PSA) and cost-effectiveness acceptability curves (CEAC) for EVT were assessed in SELECT and other pivotal trials.Results From 361 patients enrolled in SELECT, 105 had large core on CT or CTP (EVT 62, MM 43). 19 (31%) EVT vs 6 (14%) MM patients achieved modified Rankin Scale (mRS) score 0–2 (OR 3.27, 95% CI 1.11 to 9.62, P=0.03) with a shift towards better mRS (cOR 2.12, 95% CI 1.05 to 4.31, P=0.04). Over the projected lifetime of patients presenting with large core, EVT led to incremental costs of $33 094 and a gain of 1.34 QALYs per patient, resulting in ICER of $24 665 per QALY. EVT has a higher NMB compared with MM at lower (EVT -$42 747, MM -$76 740) and upper (EVT $155 041, MM $57 134) WTP thresholds. PSA confirmed the results and CEAC showed 77% and 92% acceptability of EVT at the WTP of $50 000 and $100 000, respectively. EVT was associated with an increment of $29 225 in societal costs. The pivotal EVT trials (HERMES, DAWN, DEFUSE 3) were dominant in a sensitivity analysis at the same inputs, with societal cost-savings of $37 901, $86 164 and $22 501 and a gain of 1.62, 2.36 and 2.21 QALYs, respectively.Conclusions In a non-randomized prospective cohort study, EVT resulted in better outcomes in large core patients with higher QALYs, NMB and high cost-effectiveness acceptability rates at current WTP thresholds. Randomized trials are needed to confirm these results.Clinical trial registration NCT02446587 The data that support the findings of this study are available from the corresponding author (AS) upon reasonable request.