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Updated: Aug 21, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke: generalizability across implementation
Joyce S Balami1, Gary A Ford2, Alastair M Buchan3
1Acute Stroke Programme, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Neuroscience Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Background And Purpose:
Mechanical thrombectomy (MT) is a cost-effective treatment for large-vessel occlusion stroke. However, existing economic evaluations rely on restrictive assumptions regarding care pathways and resource use, limiting their applicability to real-world implementation. We evaluated the cost and cost-effectiveness implications of implementing MT across alternative, empirically observed clinical pathways in England to address this source of decision uncertainty.
Methods:
A state-transition Markov model was populated with detailed United Kingdom clinical, outcome, and micro-costing data from five thrombectomy centres in England to compare MT with standard care. Alternative implementation scenarios reflected real-world variation in treatment pathways, including intervention-centre type, anaesthesia use, intensive care unit setting, and models of care. Scenarios were characterised using detailed pathway and cost data. Costs and quality-adjusted life-years were evaluated over a 5-year time horizon from National Health Service and societal perspectives.
Results:
Mean procedural costs for MT were £6,135 (95% CI, £5,961-£6,318) per patient in the primary analysis, compared with £7,283 in the earlier protocol-based model. Over 5 years, MT was a dominant intervention, associated with both lower costs and improved health outcomes compared with standard care. Mean cost savings were £2,297 per patient, corresponding to an estimated annual saving of £52.6 million if all 22,908 potentially eligible patients were treated. Across all five centres and implementation scenarios, incremental cost-effectiveness ratios consistently remained below currently accepted willingness-to-pay thresholds per quality-adjusted life-year gained.
Conclusions:
Across a range of real-world clinical pathways, MT is highly likely to be a cost-saving alternative to current practice and cost-effective at current health opportunity-cost thresholds. These findings suggest that cost-effectiveness is robust to local variation in service delivery and support broader implementation of MT within the English stroke-care system.
