title: Long-term cost-effectiveness of thrombectomy for acute ischaemic stroke in real life: An analysis based on data from the Swedish Stroke Register (Riksstroke).
abstract: Background Randomised controlled trials have demonstrated substantial clinical benefit for thrombectomy in patients with acute ischaemic stroke and proximal anterior circulation arterial occlusion. Aim We investigated the long-term cost-effectiveness of thrombectomy after thrombolysis versus thrombolysis alone using real-world outcome data on need for health care, home help and nursing home care. Methods We used real-life resource use and survival data from the Swedish Stroke Register and pooled outcomes from five randomised controlled trials published in 2015 in a newly constructed Markov cost-effectiveness model with a societal perspective. Data were stratified by age (18-64; 65-74; 75-84 years) and modified Rankin scale at three months for patients with an index ischaemic stroke in 2014 fulfilling inclusion criteria NIHSS ≥ 8 before treatment and treated with thrombolysis ( n = 710). Univariate sensitivity analyses explored robustness of results. A life-time perspective and 3% discount rate were applied. Results Thrombectomy increases the health care cost per patient (+GBP 9000) mainly because of intervention costs, but the reduced burden on the social services (home help services -GBP 13,000; nursing home care -GBP 26,000) implies overall cost savings. The average patient gain was 1.0 quality-adjusted life year (QALY) with higher gains for younger age groups. Thrombectomy was a dominant strategy in the base case and all sensitivity analyses where social services were considered. Conclusion Thrombectomy has a small effect on hospital costs except for the direct intervention cost. However, thrombectomy is highly likely to lead to substantial cost savings in the social service sector, up to four times the increase in health-care costs.
authors.affiliation: 1 Department of Clinical Sciences, Malmö, Health Economics, Lund University, Sweden.
authors.forename: Katarina
authors.initials: K
authors.lastname: Steen Carlsson
authors.affiliation: 2 Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Andsberg
authors.affiliation: 2 Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Jesper
authors.initials: J
authors.lastname: Petersson
authors.affiliation: 3 Department of Clinical Sciences and Neurology, Skane University Hospital, Lund University, Lund, Sweden.
authors.forename: Bo
authors.initials: B
authors.lastname: Norrving
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000191:economics* / Q000601:surgery*; D003362:Cost-Benefit Analysis; D003663:Decision Trees; D017048:Health Care Costs; D006801:Humans; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012042:Registries; D020521:Stroke / Q000191:economics* / Q000601:surgery*; D013548:Sweden; D017131:Thrombectomy / Q000191:economics*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Endovascular thrombectomy; acute ischaemic stroke; burden on social services; long term cost-effectiveness