title: Cost-Utility Analysis of Mechanical Thrombectomy Using Stent Retrievers in Acute Ischemic Stroke.
abstract: OBJECTIVE
  Recently, 5 randomized controlled trials demonstrated the benefit of endovascular therapy compared with intravenous tissue-type plasminogen activator in acute stroke. Economic evidence evaluating stent retrievers is limited. We compared the cost-effectiveness of intravenous tissue-type plasminogen activator alone versus mechanical thrombectomy and intravenous tissue-type plasminogen activator as a bridging therapy in eligible patients in the UK National Health Service.
  
  
  METHODS
  A model-based cost-utility analysis was performed using a lifetime horizon. A Markov model was constructed and populated with probabilities, outcomes, and cost data from published sources, including 1-way and probabilistic sensitivity analysis.
  
  
  RESULTS
  Mechanical thrombectomy was more expensive than intravenous tissue-type plasminogen activator, but it improved quality-adjusted life expectancy. The incremental cost per (quality-adjusted life year) gained of mechanical thrombectomy over a 20 year period was $11 651 (£7061). The probabilistic sensitivity analysis demonstrated that thrombectomy had a 100% probability of being cost-effective at the minimum willingness to pay for a quality-adjusted life year commonly used in United Kingdom.
  
  
  CONCLUSIONS
  Although the upfront costs of thrombectomy are high, the potential quality-adjusted life year gains mean this intervention is cost-effective. This is an important factor for consideration in deciding whether to commission this intervention.
authors.affiliation: From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.).
authors.forename: Jeban
authors.initials: J
authors.lastname: Ganesalingam
authors.affiliation: From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.).
authors.forename: Elena
authors.initials: E
authors.lastname: Pizzo
authors.affiliation: From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.).
authors.forename: Stephen
authors.initials: S
authors.lastname: Morris
authors.affiliation: From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.).
authors.forename: Tom
authors.initials: T
authors.lastname: Sunderland
authors.affiliation: From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.).
authors.forename: Diane
authors.initials: D
authors.lastname: Ames
authors.affiliation: From the Department of Stroke Medicine, Imperial College Healthcare NHS Trust, London, UK (J.G., D.A.); Department of Applied Health Research, University College London, London, UK (E.P., S.M.); Department of Market Access, Pricing and Outcomes Research, Boehringer Ingelheim Ltd, Bracknell, Berks, UK (T.S.); and Imaging Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK (K.L.). kyriakos.lobotesis@imperial.nhs.uk.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Lobotesis
mesh_terms: D002545:Brain Ischemia / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D003362:Cost-Benefit Analysis; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000191:economics*; D019057:Quality-Adjusted Life Years; D015607:Stents / Q000191:economics*; D020521:Stroke / Q000188:drug therapy / Q000191:economics* / Q000601:surgery; D017131:Thrombectomy / Q000191:economics* / Q000379:methods; D010959:Tissue Plasminogen Activator / Q000191:economics* / Q000627:therapeutic use; D006113:United Kingdom
chemical_list: D010959:Tissue Plasminogen Activator
keywords: cost-effectiveness; stents; stroke; thrombectomy; tissue-type plasminogen activator