Cost-Effectiveness of Endovascular Thrombectomy in Patients with Large Ischemic Stroke

Lan Gao, Leonid Churilov, Hannah Johns, Deep Pujara, Ameer E. Hassan, Michael Abraham, Santiago Ortega-Gutierrez, Muhammad Shazam Hussain, Michael Chen, Spiros Blackburn, Clark W. Sitton, Florentina M. E. Pinckaers, Wim H. van Zwam, Georgios Tsivgoulis, Michael D. Hill, James C. Grotta, Scott Kasner, Marc Ribo, Bruce C. Campbell, Amrou Sarraj*SELECT2 investigators

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Objectives: Whereas highly cost-effective and cost-saving for patients with small infarcts, whether endovascular thrombectomy (EVT) remains cost-effective in patients with extensive ischemic injury is uncertain. Methods: We conducted a model-based cost-effectiveness analysis from the United States, Australian, and Spanish societal perspectives, using a 7-state Markov model, with each state defined by the modified Rankin Scale (mRS) score. Initial probabilities at 3 months were derived from the SELECT2 trial. All other model inputs, including transition probabilities, health care and non-health care costs, and utility weights, were sourced from published literature and government websites. Our analysis included extensive sensitivity and subgroup analyses. Results: EVT in patients with large ischemic stroke improved health outcomes and was associated with lower costs from a societal viewpoint. EVT was cost-effective with a mean between-group difference of 1.24 quality-adjusted life years (QALYs), and a cost-saving of $23,409 in the United States, $10,691 in Australia, and $30,036 in Spain, in addition to uncosted benefits in productivity for patients and carers. Subgroup analyses were directionally consistent with the overall population, notably with preserved cost-effectiveness in older patients (≥ 70 years) and those with more severe strokes (National Institutes of Health Stroke Scale [NIHSS] ≥ 20). Sensitivity analyses were largely consistent with the base-case results. Interpretation: EVT demonstrated cost-effectiveness in patients with large core across different settings in the United States, Australia, and Spain, including older patients and those with more severe strokes. These results further support adaptation of systems of care to accommodate the expansion of thrombectomy eligibility to patients with large cores and maximize EVT benefits. ANN NEUROL 2025;97:222–231.

Original languageEnglish
Pages (from-to)222-231
Number of pages10
JournalAnnals of Neurology
Volume97
Issue number2
DOIs
Publication statusPublished - Feb 2025

Keywords

  • TISSUE-PLASMINOGEN ACTIVATOR
  • LARGE VESSEL OCCLUSION
  • RECURRENT STROKE
  • DISABILITY
  • THRESHOLD
  • RISK

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