A systematic review of economic evaluations on stent-retriever thrombectomy for acute ischemic stroke

Boudour, Sofia; Barral, Marine; Gory, Benjamin; Giroudon, Caroline; Aulagner, G.; Schott, Anne-Marie; Turjman, Francis; Viprey, Marie; Armoiry, Xavier

doi:10.1007/s00415-018-8760-8

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…It is the most significant cause of non-traumatic disability. Thrombectomy has been shown to be cost-effective [13,14,34]. However, it is possible that widespread use of thrombectomy may increase the number of severely disabled patients who will require constant care and result in increased expense not only for the procedure but for subsequent follow-up.…”

Section: Health Economicsmentioning

confidence: 99%

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Which patients with acute stroke due to proximal occlusion should not be treated with endovascular thrombectomy?

et al. 2018

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Section: Health Economicsmentioning

confidence: 99%

“…The further incentive can be found in the dismal natural history of acute proximal occlusion and the low complication rate of thrombectomy, in trials and registries [1]. Based on data from randomized controlled trials, the procedure is cost-effective [12][13][14].…”

mentioning

confidence: 99%

Which patients with acute stroke due to proximal occlusion should not be treated with endovascular thrombectomy?

et al. 2018

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“…[7][8][9][10][11][12][13][14][15][16][17][18] Recent systematic reviews found inconsistent results from these models with some authors concluding that EVT was cost-saving (less costly and more effective) than usual care, and other studies suggesting that EVT was costeffective (below the accepted threshold of a cost per qualityadjusted life year [QALY], but not cost savings). 19,20 Variability between study conclusions was attributed to time horizon, model perspective, and healthcare system. 19,20 While the literature surrounding EVT for ischemic stroke has investigated both the effectiveness and the cost-effectiveness, the planned a priori economic evaluation of the ESCAPE trial has not yet been reported.…”

Section: Introductionmentioning

confidence: 99%

A Prospective Economic Evaluation of Rapid Endovascular Therapy for Acute Ischemic Stroke

Sevick

Demchuk

Shuaib

et al. 2021

Can. J. Neurol. Sci.

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Background: During the Randomized Assessment of Rapid Endovascular Treatment (EVT) of Ischemic Stroke (ESCAPE) trial, patient-level micro-costing data were collected. We report a cost-effectiveness analysis of EVT, using ESCAPE trial data and Markov simulation, from a universal, single-payer system using a societal perspective over a patient’s lifetime. Methods: Primary data collection alongside the ESCAPE trial provided a 3-month trial-specific, non-model, based cost per quality-adjusted life year (QALY). A Markov model utilizing ongoing lifetime costs and life expectancy from the literature was built to simulate the cost per QALY adopting a lifetime horizon. Health states were defined using the modified Rankin Scale (mRS) scores. Uncertainty was explored using scenario analysis and probabilistic sensitivity analysis. Results: The 3-month trial-based analysis resulted in a cost per QALY of $201,243 of EVT compared to the best standard of care. In the model-based analysis, using a societal perspective and a lifetime horizon, EVT dominated the standard of care; EVT was both more effective and less costly than the standard of care (−$91). When the time horizon was shortened to 1 year, EVT remains cost savings compared to standard of care (∼$15,376 per QALY gained with EVT). However, if the estimate of clinical effectiveness is 4% less than that demonstrated in ESCAPE, EVT is no longer cost savings compared to standard of care. Conclusions: Results support the adoption of EVT as a treatment option for acute ischemic stroke, as the increase in costs associated with caring for EVT patients was recouped within the first year of stroke, and continued to provide cost savings over a patient’s lifetime. Clinical Trial Registration: NCT01778335

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“…1 The clinical and cost effectiveness of mechanical thrombectomy (MT) with or without intravenous thrombolysis (IVT) for the treatment of large vessel occlusion stroke are both well established. [2][3][4][5][6] Despite the evidence, detailed costs of delivering MT within most healthcare economies, including the UK NHS, remain unclear. Evidence on the main drivers of cost and its variability are also sparse.…”

Section: Introductionmentioning

confidence: 99%

The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

et al. 2020

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Method This was a multicentre retrospective study using microcosting methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018. Results Data were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527-11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649-8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381-1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345-2,719; p<0001).

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A systematic review of economic evaluations on stent-retriever thrombectomy for acute ischemic stroke

Cited by 18 publications

References 31 publications

Which patients with acute stroke due to proximal occlusion should not be treated with endovascular thrombectomy?

Which patients with acute stroke due to proximal occlusion should not be treated with endovascular thrombectomy?

A Prospective Economic Evaluation of Rapid Endovascular Therapy for Acute Ischemic Stroke

The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

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