Cost-effectiveness of the ABCStroke pathway in ischaemic stroke care: a UK pilot analysis

The ABCStroke pathway is a structured, person-centred approach to post-stroke care encompassing antithrombotic therapy, functional and psychological optimization, and cardiovascular risk factor management, proposed by the European Society of Cardiology Council on Stroke. Adherence to the pathway has been associated with improved outcomes in observational studies, but its cost-effectiveness remains unknown. We evaluated the long-term cost-effectiveness of the ABCStroke pathway in the UK.

A Markov model was developed to simulate lifetime costs and outcomes of patients following an ischaemic stroke, using clinical data from the Athens Stroke Registry and UK-specific cost and utility inputs from the Oxford Vascular Study. Patients were stratified by adherence to all three ABCStroke pathway components vs. non-adherence. Over a 20-year horizon, pathway-aligned/adherent care was associated with higher costs (£129 143 vs. £71 472) and greater quality-adjusted life years (QALYs; 9.84 vs. 5.94), yielding an incremental cost-effectiveness ratio (ICER) of £14 804 per QALY gained. At a willingness-to-pay threshold of £25 000 per QALY, the net monetary benefit of the ABCStroke pathway was £116,857, compared with £77 028 for non-aligned care, indicating a net gain of £39 829 in favour of the ABC-aligned strategy. Deterministic sensitivity analyses showed the ICER remained below £16 000 per QALY across plausible parameter ranges. Even assuming a 100-fold increase in pathway implementation costs, the strategy remained within or near the lower boundary of the UK National Institute for Health and Care Excellence willingness-to-pay threshold.

In the UK, implementation of the ABCStroke pathway is cost-effective. These findings support strategic investment in structured, multidisciplinary integrated care for stroke survivors.