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. 2021 Dec;13(12):1117-1123.
doi: 10.1136/neurintsurg-2020-016930. Epub 2020 Dec 21.

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Osama O Zaidat  1 , Marc Ribo  2   3 , Heinrich Paul Mattle  4 , Jeffrey L Saver  5 , Hormozd Bozorgchami  6 , Albert J Yoo  7 , Alexandra Ehm  8 , Emilie Kottenmeier  9 , Heather L Cameron  10 , Rana A Qadeer  10 , Tommy Andersson  11   12
Affiliations

Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective

Osama O Zaidat et al. J Neurointerv Surg. 2021 Dec.

Abstract

Background: First-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed.

Objective: To assess the economic impact of achieving complete or near complete reperfusion after the first pass.

Methods: Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c-3 was achieved, stratified into two groups: (1) mTICI 2c-3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK).

Results: Among patients who achieved mTICI 2c-3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0-2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24-33% reduction) and annual care (11-27% reduction) costs across all countries.

Conclusions: FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.

Keywords: economics; stroke; thrombectomy.

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Conflict of interest statement

Competing interests: OOZ serves as a consultant for Neuravi, Stryker, Penumbra, and Medtronic. MR is a shareholder in Anaconda Biomed; consultant for Neuravi/Cerenovus, Medtronic, Stryker, Apta Targets, and Vesalio. HPM reports personal fees from Covidien/Medtronic, Neuravi/Cerenovus, Servier, and Bayer outside the submitted work; served on the steering committees of the SWIFT PRIME and ARISE studies. JLS is an employee of the University of California, which holds a patent on retriever devices for stroke. The University of California, Regents receives funding for the services of JLS as a scientific consultant regarding trial design and conduct to Covidien/Medtronic and Stryker; serves as a consultant for Modest, Abbott, Medtronic, Stryker, and Neuravi/Cerenovus; has contracted stock options for Modest and Rapid Medical. HB serves as a modest consultant for Neuravi/Cerenovus, and Stryker. AJY is a consultant for Cerenovus, Penumbra, Genentech, and Zoll Circulation; receives research grant support from Cerenovus, Penumbra, Medtronic, Stryker, and Genentech; and has equity interest in Insera Therapeutics. AE is an employee of Johnson and Johnson. EK is an employee of Cerenovus, a subsidiary of Johnson and Johnson. HLC and RAQ are paid consultants for Cerenovus. TA is a consultant for Neuravi/Cerenovus, Anaconda, Amnis Therapeutics, and Rapid Medical; served on the steering committees of the ARISE studies.

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