title: Novel model of direct and indirect cost-benefit analysis of mechanical embolectomy over IV tPA for large vessel occlusions: a real-world dollar analysis based on improvements in mRS.
abstract: BACKGROUND
  Ischemic strokes result in significant healthcare expenditures (direct costs) and loss of quality-adjusted life years (QALYs) (indirect costs). Interventional therapy has demonstrated improved functional outcomes in patients with large vessel occlusions (LVOs), which are likely to reduce the economic burden of strokes.
  
  
  OBJECTIVE
  To develop a novel real-world dollar model to assess the direct and indirect cost-benefit of mechanical embolectomy compared with medical treatment with intravenous tissue plasminogen activator (IV tPA) based on shifts in modified Rankin scores (mRS).
  
  
  METHODS
  A cost model was developed including multiple parameters to account for both direct and indirect stroke costs. These were adjusted based upon functional outcome (mRS). The model compared IV tPA with mechanical embolectomy to assess the costs and benefits of both therapies. Direct stroke-related costs included hospitalization, inpatient and outpatient rehabilitation, home care, skilled nursing facilities, and long-term care facility costs. Indirect costs included years of life expectancy lost and lost QALYs. Values for the model cost parameters were derived from numerous resources and functional outcomes were derived from the MR CLEAN study as a reflective sample of LVOs. Direct and indirect costs and benefits for the two treatments were assessed using Microsoft Excel 2013.
  
  
  RESULTS
  This cost-benefit model found a cost-benefit of mechanical embolectomy over IV tPA of $163 624.27 per patient and the cost benefit for 50 000 patients on an annual basis is $8 181 213 653.77.
  
  
  CONCLUSIONS
  If applied widely within the USA, mechanical embolectomy will significantly reduce the direct and indirect financial burden of stroke ($8 billion/50 000 patients).
authors.affiliation: Departments of Interventional Neuroradiology, Radiology, Neurology, Neurosurgery, SUNY Downstate Health Science Center, Brooklyn, New York, USA.|Department of Radiology, Lincoln Medical Center, Bronx, New York, USA.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Mangla
authors.affiliation: Departments of Interventional Neuroradiology, Radiology, Neurology, Neurosurgery, SUNY Downstate Health Science Center, Brooklyn, New York, USA.|Department of Radiology, Lincoln Medical Center, Bronx, New York, USA.
authors.forename: Keara
authors.initials: K
authors.lastname: O'Connell
authors.affiliation: Departments of Internal Medicine and Critical Care, Lincoln Medical Center, Bronx, New York, USA.
authors.forename: Divya
authors.initials: D
authors.lastname: Kumari
authors.affiliation: Departments of Internal Medicine and Critical Care, Lincoln Medical Center, Bronx, New York, USA.
authors.forename: Maryam
authors.initials: M
authors.lastname: Shahrzad
keywords: Economics; Intervention; Stroke; Thrombectomy; Thrombolysis