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Ischemic stroke
Original research
Cost-effectiveness of endovascular thrombectomy in patients with acute stroke and M2 occlusion
  1. Mihir Khunte1,
  2. Xiao Wu1,
  3. Sam Payabvash1,
  4. Chengcheng Zhu2,
  5. Charles Matouk3,
  6. Joseph Schindler4,
  7. Pina Sanelli5,
  8. Dheeraj Gandhi6,
  9. Ajay Malhotra1
  1. 1 Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
  2. 2 University of Washington School of Medicine, Seattle, Washington, USA
  3. 3 Department of Neurosurgery, Yale University, New Haven, Connecticut, USA
  4. 4 Department of Neurology, Yale University, New Haven, Connecticut, USA
  5. 5 Hofstra Northwell School of Medicine at Hofstra University, Hempstead, New York, USA
  6. 6 Department of Interventional Neuroradiology, University of Maryland, Baltimore, Maryland, USA
  1. Correspondence to Dr Ajay Malhotra, Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06520-8055, USA; ajay.malhotra{at}yale.edu

Abstract

Background The cost-effectiveness of endovascular thrombectomy (EVT) in patients with acute ischemic stroke due to M2 branch occlusion remains uncertain.

Objective To evaluate the cost-effectiveness of EVT compared with medical management in patients with acute stroke presenting with M2 occlusion using a decision-analytic model.

Methods A decision-analytic study was performed with Markov modeling to estimate the lifetime quality-adjusted life years and associated costs of EVT-treated patients compared with no-EVT/medical management. The study was performed over a lifetime horizon with a societal perspective in the Unites States setting. Base case, one-way, two-way, and probabilistic sensitivity analyses were performed.

Results EVT was the long-term cost-effective strategy in 93.37% of the iterations in the probabilistic sensitivity analysis, and resulted in difference in health benefit of 1.66 QALYs in the 65-year-old age groups, equivalent to 606 days in perfect health. Varying the outcomes after both strategies shows that EVT was more cost-effective when the probability of good outcome after EVT was only 4–6% higher relative to medical management in clinically likely scenarios. EVT remained cost-effective even when its cost exceeded US$200 000 (threshold was US$209 111). EVT was even more cost-effective for 55-year-olds than for 65-year-old patients.

Conclusion Our study suggests that EVT is cost-effective for treatment of acute M2 branch occlusions. Faster and improved reperfusion techniques would increase the relative cost-effectiveness of EVT even further in these patients.

  • stroke
  • thrombectomy

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/neurintsurg-2020-016765

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Twitter @AjayMalhotraRad

    • Contributors AM: Study concept and design, acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content, study supervision. MK, XW: Acquisition of data, analysis and interpretation, critical revision of the manuscript for important intellectual content. SP: Acquisition of data, critical revision of the manuscript for important intellectual content. CZ, CM, JS, PS, DG: Acquisition of data, critical revision of the manuscript for important intellectual content, study supervision.

    • 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 None declared.

    • 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.