The economic impact of stent retriever selection for acute ischemic stroke: a cost analysis of MASTRO I from the healthcare system perspective of the United States, Canada and eight European countries

Abstract

Aim: According to the results of the MASTRO I living systematic review and meta-analysis, use of the EmboTrap Revascularization^® Device in the treatment of acute ischemic stroke (AIS) results in higher rates of good functional outcomes (90-day modified Rankin Scale [mRS] 0-2) compared with use of the Trevo^® Retriever or the Solitaire™ Revascularization Device. The aim of this analysis was to assess the potential economic impact of achieving improved functional outcomes for three commonly used stent retrievers (SRs) in the treatment of AIS. Methods: An economic model with short-term and long-term costs, representing a healthcare system perspective was developed using a decision tree to simulate a cohort of 1000 hypothetical patients treated for AIS with mechanical thrombectomy (MT) using EmboTrap, Trevo or Solitaire SRs. Based on the proportion of patients who achieved a 90-day mRS score of 0-2 or 3-5 for each device reported in MASTRO I (excluding patients not surviving after 90 days), this model estimated per-patient costs and the associated incremental cost savings. Results are reported from the healthcare system perspective in the US, Canada, the UK, Sweden, Germany, France, Italy, Spain, Belgium and The Netherlands. Results: Across all ten countries, the use of EmboTrap during MT was associated with the lowest short-term (ranging from €8412 in Italy to $66,525 in the US), long-term (ranging from €5249 in Italy to $25,757 in the US) and total (ranging from €13,661 in Italy to $92,282 in the US) per-patient costs. The total per-patient cost was higher with Trevo (ranging from €14,601 in Italy to $97,487 in the US) and Solitaire (ranging from €14,840 in Italy to $98,814 in the US). Cost savings were highest when comparing EmboTrap versus Solitaire, followed by EmboTrap versus Trevo, with Trevo versus Solitaire having the smallest cost savings. Results of sensitivity and scenario analyses supported the robustness of the base-case results. Conclusion: Across the ten countries, treating patients with AIS with EmboTrap resulted in lower short-term, long-term and total costs to the payer. With rising healthcare costs and limited hospital budgets, these results suggest EmboTrap proves to be an evidence-based economical choice of SR for hospitals and healthcare systems.

Keywords: EmboTrap; MASTRO I; Solitaire; Trevo; acute ischemic stroke; cost; economic; mechanical thrombectomy; modified Rankin Scale; stent retriever.

Graphical abstract

Figure 1.. Decision trees for stent retriever selection in treating acute ischemic stroke.

The decision tree depicts possible branches of treatments for the treatment of AIS for patients who were treated with (A) EmboTrap versus Trevo, (B) EmboTrap versus Solitaire, (C) Solitaire versus Trevo and were alive 90-days post-treatment. The square represents the node between receiving treatment with EmboTrap and either Solitaire or Trevo. The circle represents the node between the two possible mRS scores the patient can achieve: mRS 0–2 or 3–5. The triangle represents the economic outcomes associated with achieving the mRS score. AIS: Acute ischemic stroke; mRS: modified Rankin Scale; MT: Mechanical thrombectomy; SR: Stent retriever.

Figure 2.. Comparison of country-specific long-term costs included in the model.

The figure depicts the cost categories that are included in the country-specific long-term costs included in the model. Green cells indicate that the cost is included in the long-term cost input used in the model. *Includes visits to emergency room. **Also includes day cases.

Figure 3.. Overall time horizon of the short- and long-term analyses.

mRS: 90-day modified Rankin Scale score.

Figure 4.. Per-patient pairwise comparison of total cost savings.