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Comparative Study
. 2015 Sep;46(9):2591-8.
doi: 10.1161/STROKEAHA.115.009396. Epub 2015 Aug 6.

Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke

Jeban Ganesalingam  1 , Elena Pizzo  1 , Stephen Morris  1 , Tom Sunderland  1 , Diane Ames  1 , Kyriakos Lobotesis  2
Affiliations
Comparative Study

Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke

Jeban Ganesalingam et al. Stroke. 2015 Sep.

Abstract

Background and purpose: Recently, 5 randomized controlled trials demonstrated the benefit of endovascular therapy compared with intravenous tissue-type plasminogen activator in acute stroke. Economic evidence evaluating stent retrievers is limited. We compared the cost-effectiveness of intravenous tissue-type plasminogen activator alone versus mechanical thrombectomy and intravenous tissue-type plasminogen activator as a bridging therapy in eligible patients in the UK National Health Service.

Methods: A model-based cost-utility analysis was performed using a lifetime horizon. A Markov model was constructed and populated with probabilities, outcomes, and cost data from published sources, including 1-way and probabilistic sensitivity analysis.

Results: Mechanical thrombectomy was more expensive than intravenous tissue-type plasminogen activator, but it improved quality-adjusted life expectancy. The incremental cost per (quality-adjusted life year) gained of mechanical thrombectomy over a 20 year period was $11 651 (£7061). The probabilistic sensitivity analysis demonstrated that thrombectomy had a 100% probability of being cost-effective at the minimum willingness to pay for a quality-adjusted life year commonly used in United Kingdom.

Conclusions: Although the upfront costs of thrombectomy are high, the potential quality-adjusted life year gains mean this intervention is cost-effective. This is an important factor for consideration in deciding whether to commission this intervention.

Keywords: cost-effectiveness; stents; stroke; thrombectomy; tissue-type plasminogen activator.

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Figures

Figure 1.
Figure 1.
Decision model. A, Short-run analytic model. B, Long-run Markov model structure. IV-tPA indicates intravenous tissue-type plasminogen activator; and mRS, modified Rankin Scale.
Figure 2.
Figure 2.
Cost-effectiveness acceptability curves showing the probability that each option is cost-effective at different values of the willingness to pay for a quality-adjusted life years (QALY). In the United Kingdom, the lower and upper limit of the maximum willingness to pay for a QALY are $33 000 (£20 000) and $49 500 (£30 000) respectively.
Figure 3.
Figure 3.
Monte Carlo simulations of incremental cost per quality-adjusted life years (QALY) gained of the mechanical thrombectomy on a cohort of 1000 patients.
See this image and copyright information in PMC

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