Mechanical thrombectomy in patients with acute ischemic stroke: a cost-effectiveness and value of implementation analysis

Heggie, R., Wu, O. , White, P., Ford, G. A., Wardlaw, J., Brown, M. M., Clifton, A. and Muir, K. W. (2020) Mechanical thrombectomy in patients with acute ischemic stroke: a cost-effectiveness and value of implementation analysis. International Journal of Stroke, 15(8), pp. 881-898. (doi: 10.1177/1747493019879656) (PMID:31564243)

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Abstract

Background: Recent clinical trials have demonstrated the efficacy of mechanical thrombectomy in acute ischemic stroke. Aims: To determine the cost-effectiveness, value of future research, and value of implementation of mechanical thrombectomy. Methods: Using UK clinical and cost data from the Pragmatic Ischemic Stroke Thrombectomy Evaluation (PISTE) trial, we estimated the cost-effectiveness of mechanical thrombectomy over time horizons of 90-days and lifetime, based on a decision-analytic model, using all existing evidence. We performed a meta-analysis of seven clinical trials to estimate treatment effects. We used sensitivity analysis to address uncertainty. Value of implementation analysis was used to estimate the potential value of additional implementation activities to support routine delivery of mechanical thrombectomy. Results: Over the trial period (90 days), compared with best medical care alone, mechanical thrombectomy incurred an incremental cost of £5207 and 0.025 gain in QALY (incremental cost-effectiveness ratio (ICER) £205,279), which would not be considered cost-effective. However, mechanical thrombectomy was shown to be cost-effective over a lifetime horizon, with an ICER of £3466 per QALY gained. The expected value of perfect information per patient eligible for mechanical thrombectomy in the UK is estimated at £3178. The expected value of full implementation of mechanical thrombectomy is estimated at £1.3 billion over five years. Conclusion: Mechanical thrombectomy was cost-effective compared with best medical care alone over a patient’s lifetime. On the assumption of 30% implementation being achieved throughout the UK healthcare system, we estimate that the population health benefits obtained from this treatment are greater than the cost of implementation. Trial registration: NCT01745692.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Wu, Professor Olivia and Muir, Professor Keith and Heggie, Mr Robert
Authors: Heggie, R., Wu, O., White, P., Ford, G. A., Wardlaw, J., Brown, M. M., Clifton, A., and Muir, K. W.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
College of Medical Veterinary and Life Sciences > Institute of Neuroscience and Psychology
Journal Name:International Journal of Stroke
Publisher:SAGE Publications
ISSN:1747-4930
ISSN (Online):1747-4949
Published Online:30 September 2019
Copyright Holders:Copyright © 2019 World Stroke Organization
First Published:First published in International Journal of Stroke 15(8): 881-898
Publisher Policy:Reproduced in accordance with the copyright policy of the publisher

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