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. 2024;58(1):47-56.
doi: 10.1159/000535796. Epub 2023 Dec 21.

Endovascular Thrombectomy with or without Bridging Thrombolysis in Acute Ischemic Stroke: A Cost-Effectiveness Analysis

Rami Z Morsi  1 , Yuan Zhang  2 , Meng Zhu  2 , Shitong Xie  3 , Julián Carrión-Penagos  4 , Harsh Desai  4 , Elie Tannous  5 , Sachin A Kothari  4 , Assem Khamis  6 , Andrea J Darzi  2 , Ammar Tarabichi  7 , Reena Bastin  4 , Layal Hneiny  8 , Sonam Thind  4 , James E Siegler  4 , Elisheva R Coleman  4 , Scott J Mendelson  4 , Ali Mansour  4 , Shyam Prabhakaran  4 , Tareq Kass-Hout  4
Affiliations

Endovascular Thrombectomy with or without Bridging Thrombolysis in Acute Ischemic Stroke: A Cost-Effectiveness Analysis

Rami Z Morsi et al. Neuroepidemiology. 2024.

Abstract

Background: There is unclear added benefit of intravenous thrombolysis (IVT) with endovascular thrombectomy (EVT). We performed a cost-effectiveness analysis to assess the cost-effectiveness of comparing EVT with IVT versus EVT alone.

Methods: We used a decision tree to examine the short-term costs and outcomes at 90 days after the occurrence of index stroke to compare the cost-effectiveness of EVT alone with EVT plus IVT for patients with stroke. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1-year, 5-year, and 20-year time horizons. We estimated total and incremental cost, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio.

Results: The average costs per patient were estimated to be $47,304, $49,510, $59,770, and $76,561 for EVT-only strategy and $55,482, $57,751, $68,314, and $85,611 for EVT with IVT over 90 days, 1 year, 5 years, and 20 years, respectively. The cost saving of EVT-only strategy was driven by the avoided medication costs of IVT (ranging from $8,178 to $9,050). The additional IVT led to a slight decrease in QALY estimate during the 90-day time horizon (loss of 0.002 QALY), but a small gain over 1-year and 5-year time horizons (0.011 and 0.0636 QALY). At a willingness-to-pay threshold of $50,000 per QALY gained, the probabilities of EVT only being cost-effective were 100%, 100%, and 99.3% over 90-day, 1-year, and 5-year time horizons.

Conclusion: Our cost-effectiveness model suggested that EVT only may be cost-effective for patients with acute ischemic stroke secondary to large vessel occlusion.

Keywords: Cost; Cost-effectiveness; Stroke; Thrombectomy; Thrombolytic.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1.
Fig. 1.
Decision tree – outcomes in short term (0–90 days after first stroke incidence).
Fig. 2.
Fig. 2.
Markov model – outcomes in long term (90 days after first stroke incidence).
Fig. 3.
Fig. 3.
Cost-effectiveness over 20-year horizon.
See this image and copyright information in PMC

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  • Costs of Neurological Disorders.
    Cadilhac DA, Mahal A. Cadilhac DA, et al. Neuroepidemiology. 2024;58(6):409-411. doi: 10.1159/000539370. Epub 2024 May 22. Neuroepidemiology. 2024. PMID: 38768584 Free PMC article. No abstract available.

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