Mechanical Thrombectomy for Patients with Large Core Ischemic Strokes-An International Cost-Effectiveness Analysis

Recent trials demonstrate mechanical thrombectomy (MT) benefits patients with large core infarcts. This study assesses the cost-effectiveness of MT in this population across a range of international health care systems.

A decision tree model coupled with a Markov model compared MT with medical management. Clinical outcomes, quality-adjusted life years, and costs were projected over a lifetime horizon. Data from recent randomized controlled trials and country-specific cost inputs informed the model. Univariate, bivariate deterministic, and probabilistic sensitivity analyses assessed parameter uncertainty.

MT was consistently cost effective across all 11 health care systems, even though the magnitude of cost savings or added costs varied. Although MT resulted in net cost savings in Belgium, it was associated with increased costs in Australia and China; however, even in these systems, the added cost per quality-adjusted life year gained remained within acceptable thresholds. Incremental quality-adjusted life years gains were consistent across systems (1.16-1.98). Incremental cost-effectiveness ratios were below $20 000/quality-adjusted life years in all countries. Sensitivity analyses confirmed the robustness of these findings. Acute care costs for severely disabled patients (modified Rankin Scale score 4-6) most influenced cost-effectiveness.

Our study demonstrates the consistent value of mechanical thrombectomy for large core stroke patients across various health care settings, even with differences in costs between countries. This supports expanding mechanical thrombectomy access, which, although requiring investment, offers the potential for long-term cost-effectiveness through reduced disability and improved quality of life. It is important to note that this analysis adopts a health care system perspective, excluding indirect costs, and that assumptions regarding long-term outcomes may even potentially lead to an underestimation of the comprehensive cost-effectiveness of MT.