Cost-Effectiveness of Intra-Arterial Treatment as an Adjunct to Intravenous Tissue-Type Plasminogen Activator for Acute Ischemic Stroke

Abstract

Background and Purpose The objective of this study was to determine the cost-effectiveness of intraarterial treatment within the 0- to 6- hour window after intravenous (IV) tissue plasminogen activator (tPA) within 0- to 4.5-hours compared to IV tPA alone, in the US setting and from a social perspective. Methods A decision analytic model estimated the lifetime costs and outcomes associated with the additional benefit of intraarterial therapy compared to standard treatment with IV tPA alone. Model inputs were obtained from published literature, the MR CLEAN study, and claims databases in the United States. Health outcomes were measured in quality adjusted life years (QALYs). Treatment benefit was assessed by calculating the cost per QALY gained. One-way and probabilistic sensitivity analyses were performed to estimate the overall uncertainty of model results. Results The addition of intraarterial therapy compared with standard treatment alone yielded a lifetime gain of 0.7 QALY for an additional cost of $9,911, which resulted in a cost of $14,137 per QALY. Multivariable sensitivity analysis predicted cost-effectiveness (≤$50,000 per QALY) in 97.6% of simulation runs. Conclusion Intraarterial treatment after IV tPA for patients with anterior circulation strokes within the 6 hour window is likely cost effective. From a societal perspective, increased investment in access to intraarterial treatment for acute stroke may be justified.

Mechanical thrombectomy in patients with acute ischemic stroke: a cost-utility analysis

“…This is concordant with the large clinical effect size observed in the randomized trials, and sensitivity analyses suggested that these findings are robust to a range of assumptions. Our findings were consistent with the most recent published economic evaluation from the United States, 22 which evaluated new-generation devices and used efficacy estimates from a single *This study 31 did not find a significant difference in mortality between groups (28.8% mRS 6 in the endovascular treatment group v. 34% in the IT group). Therefore, we assumed no survival benefit for MT in this scenario analysis.…”

Cost benefits of rapid recanalization using intraarterial thrombectomy

“…The acute management costs for IAT usually increases the standard costs required for IVT, given the expensive devices used and expert personnel required to perform the IAT (Ganesalingam et al., 2015; Leppert et al., 2015). However, these high costs may be considered acceptable given the incremental lifetime cost‐effectiveness ratio of IAT costs remained within a willingness to pay threshold of ≤$50,000/QALY (Ganesalingam et al., 2015; Leppert et al., 2015). We here separately compared the costs of acute IAT management and those of long‐term institutional rehabilitation after IAT.…”

“…While IAT is more expensive and requires specialized personnel, its high cost is justified by the improved lifetime clinical outcomes and cost‐effectiveness (Aronsson, Persson, Blomstrand, Wester, & Levin, 2016; Ganesalingam et al., 2015; Leppert, Campbell, Simpson, & Burke, 2015). However, the long‐term (>3 months post‐IAT) clinical and cost benefits for patients stratified according to the time from symptom onset to recanalization remain unclear.…”

An historical and contemporary review of endovascular therapy for acute ischemic stroke

“…Several cost utility and cost effectiveness analyses have suggested that although EVT is a costly procedure it is likely to be cost effective [31][32][33].…”