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Updated: Apr 5, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke
Jeban Ganesalingam1, Elena Pizzo1, Stephen Morris1
1From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.).
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.
