Mechanical thrombectomy is cost-effective versus medical management alone around Europe in patients with low ASPECTS

Abstract

ObjectiveTo demonstrate, by a cost-effectiveness analysis, the efficiency of mechanical thrombectomy (MT) versus medical management (MM) in patients with a low Alberta Stroke Program Early CT Score (ASPECTS) from the RESCUE Study.MethodsA cost-effectiveness model was designed to project both direct medical costs and quality-adjusted life-years (QALYs) of MT versus MM in eight European countries (Spain, UK, France, Italy, Belgium, Germany, Sweden, and the Netherlands). Our model was created based on previously published health-economic data in those countries. Procedure costs, acute, mid-term, and long-term care costs were projected based on expected modified Rankin Scale (mRS) scores as reported in the RESCUE-Japan LIMIT trial.ResultsMT was found to be a cost-effective option in eight different countries across Europe (Spain, Italy, UK, France, Belgium, Germany, the Netherlands, and Sweden). with a lifetime incremental cost-effectiveness ratio varying from US$2 875 to US$11 202/QALY depending on the country. A cost-effectiveness acceptability curve showed 100% acceptability of MT at the willingness to pay (WTP) of US$40 000 for the eight countries.ConclusionsMT is efficient versus MM alone for patients with low ASPECTS in eight countries across Europe. Patients with a large ischemic core could be treated with MT because it is both clinically beneficial and economically sustainable.

Large Core Thrombectomies: Are We Still Conflicted or Confident

“…It is generally accepted that offering mechanical thrombectomy would lead to significant longterm health care cost savings based on the traditional selection used. [15][16][17][18] Taking one step further, Morenu et al 19 showed that patients who underwent mechanical thrombectomy meeting the RESCUE JAPAN study criteria had a lifetime incremental cost-effectiveness ratio (incremental cost-effectiveness ratio) ranging from US $2875 to $11 202 per quality-adjusted life-years depending on the country of residence. The cost-effectiveness acceptability curve showed 100% acceptability of EVT at the willingness to pay of US $40 000 for the 8 European countries included.…”

“…The cost-effectiveness acceptability curve showed 100% acceptability of EVT at the willingness to pay of US $40 000 for the 8 European countries included. 19 Data analysis from the other completed and pending clinical trials will provide more details on differences and benefits in cost utilization depending on individual countries and health care infrastructure.…”

Region‐specific interobserver agreement of the Alberta Stroke Program Early Computed Tomography Score: A meta‐analysis

“…On the other hand, infarct topography and ASPECTS regions have unequal influence on disability. [12][13][14][15] While studies have assessed the interobserver agreement for the total ASPECT score, few have investigated the interobserver agreement for the regional scores. To the best of our knowledge, no studies have evaluated the interrater agreement of ASPECTS for both the total and per-region scores previously.…”

Large core stroke thrombectomy: paradigm shift or futile exercise?

“…The cost-effectiveness acceptability curve showed 100% acceptability of MT at the willingness to pay of US$40 000 for the eight countries. 9 Not surprisingly they found the biggest costs over time were associated with severely disabled patients (ie, mRS 4 and 5).…”

“…The authors found a lifetime incremental cost-effectiveness ratio varying from US$2875 to $11 202/quality-adjusted life year (QALY) depending on the country. The cost-effectiveness acceptability curve showed 100% acceptability of MT at the willingness to pay of US$40 000 for the eight countries 9. Not surprisingly they found the biggest costs over time were associated with severely disabled patients (ie, mRS 4 and 5).…”