Extending mechanical thrombectomy service provision to 24/7: a break-even analysis

Area of Science:

• Health Economics
• Stroke Care Management
• Health Service Provision

Background:

• Investment proposals for 24/7 mechanical thrombectomy (MT) in England focus on financial accounting.
• An affordability question arises regarding the health economic benefits versus costs of extending MT services.
• Quality-adjusted life years (QALYs) and societal cost savings are key metrics for evaluating MT's value.

Purpose of the Study:

• To determine the additional mechanical thrombectomy (MT) treatment volume needed to offset costs with health economic benefits.
• To assess the affordability of extending MT services to a 24/7 provision from a health economic perspective.

Main Methods:

• A break-even analysis was performed to calculate the required additional MT treatment volume.
• Incremental hospital costs for 24/7 MT were estimated using data from four business cases.
• A Markov chain-based model was adapted to estimate additional societal cost savings and health benefits.

Main Results:

• Annual costs for 24/7 MT extension are estimated at a mean of £3,756,818.
• An average of 750 additional eligible stroke patients treated annually makes the 24/7 service affordable.
• Additional facility and equipment costs account for 20% of the estimate.

Conclusions:

• Findings inform the debate on optimal MT treatment volumes for 24/7 services and hospital organization.
• Regional coordination is needed for equitable patient access to MT and to achieve optimal treatment volumes.
• Further research should replicate the analysis in different health service settings and decision-making contexts.