Skip to main content
AAN.com

Abstract

Objective:

To evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.

Methods:

The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model. Primary outcomes from ESCAPE, Extending the Time for Thrombolysis in Emergency Neurological Deficits–Intra-Arterial (EXTEND-IA), Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours (REVASCAT), and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke (SWIFT PRIME) along with data from published studies and registries were used in this analysis. We used a health care payer perspective and a lifelong time horizon to estimate costs and effects.

Results:

The model showed that adding thrombectomy with stent retrievers to guideline-based care (including IV thrombolysis) resulted in a gain of 0.40 life-years and 0.99 quality-adjusted life-years along with a cost savings of approximately $221 per patient. The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions.

Conclusions:

Adding endovascular treatment to standard care resulted in substantial clinical benefits at low costs. The results were consistent throughout irrespective of whether data from ESCAPE, EXTEND-IA, MR CLEAN, REVASCAT, or SWIFT PRIME were used in this model.

Get full access to this article

View all available purchase options and get full access to this article.

Supplementary Material

File (figure_e1.pdf)
File (figure_e2.pdf)
File (figure_e3.pdf)
File (table_e-1.docx)

REFERENCES

1.
Global Burden of Disease Study Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015;386:743–800.
2.
Mozaffarian D, Benjamin EJ, Go AS, et al. Heart disease and stroke statistics: 2015 update: a report from the American Heart Association. Circulation 2015;131:e29–e322.
3.
World Health Organization. The WHO Stroke Surveillance. Geneva: World Health Organization; 2004.
4.
Mukherjee D, Patil CG. Epidemiology and the global burden of stroke. World Neurosurg 2011;76:S85–S90.
5.
Dewilde S, Thijs V, Annemans L, Peeters A; Belgian Stroke Council NP. Quality of life decrements after stroke. Value Health 2014;17:A331. Abstract.
6.
Henriksson KM, Farahmand B, Johansson S, Asberg S, Terent A, Edvardsson N. Survival after stroke: the impact of CHADS2 score and atrial fibrillation. Int J Cardiol 2010;141:18–23.
7.
van Exel NJ, Koopmanschap MA, van den Berg B, Brouwer WB, van den Bos GA. Burden of informal caregiving for stroke patients: identification of caregivers at risk of adverse health effects. Cerebrovasc Dis 2005;19:11–17.
8.
Ghatnekar O, Persson U, Glader EL, Terent A. Cost of stroke in Sweden: an incidence estimate. Int J Technol Assess Health Care 2004;20:375–380.
9.
Dawson J, Lees JS, Chang TP, et al. Association between disability measures and healthcare costs after initial treatment for acute stroke. Stroke 2007;38:1893–1898.
10.
Berkhemer OA, Fransen PS, Beumer D, et al. A randomized trial of intraarterial treatment for acute ischemic stroke. N Engl J Med 2015;372:11–20.
11.
Broderick JP, Palesch YY, Demchuk AM, et al. Endovascular therapy after intravenous t-PA versus t-PA alone for stroke. N Engl J Med 2013;368:893–903.
12.
Kidwell CS, Jahan R, Gornbein J, et al. A trial of imaging selection and endovascular treatment for ischemic stroke. N Engl J Med 2013;368:914–923.
13.
Ciccone A, Valvassori L, Nichelatti M, et al. Endovascular treatment for acute ischemic stroke. N Engl J Med 2013;368:904–913.
14.
Goyal M, Demchuk AM, Menon BK, et al. Randomized assessment of rapid endovascular treatment of ischemic stroke. N Engl J Med 2015;372:1019–1030.
15.
Campbell BC, Mitchell PJ, Kleinig TJ, et al. Endovascular therapy for ischemic stroke with perfusion-imaging selection. N Engl J Med 2015;372:1009–1018.
16.
Jovin TG, Chamorro A, Cobo E, et al. Thrombectomy within 8 hours after symptom onset in ischemic stroke. N Engl J Med 2015;372:2296–2306.
17.
Saver JL, Goyal M, Bonafe A, et al. Stent-retriever thrombectomy after intravenous t-PA vs. t-PA alone in stroke. N Engl J Med 2015;372:2285–2295.
18.
Rankin J. Cerebral vascular accidents in patients over the age of 60: II: prognosis. Scott Med J 1957;2:200–215.
19.
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988;19:604–607.
20.
Dhamoon MS, Moon YP, Paik MC, et al. Long-term functional recovery after first ischemic stroke: the Northern Manhattan Study. Stroke 2009;40:2805–2811.
21.
Pennlert J, Eriksson M, Carlberg B, Wiklund PG. Long-term risk and predictors of recurrent stroke beyond the acute phase. Stroke 2014;45:1839–1841.
22.
SCB. Statistics Sweden. Life Tables 2014. Available at: http://www.scb.se/. Accessed March 1, 2015.
23.
Fang MC, Go AS, Chang Y, et al. Long-term survival after ischemic stroke in patients with atrial fibrillation. Neurology 2014;82:1033–1037.
24.
Hankey GJ, Jamrozik K, Broadhurst RJ, et al. Five-year survival after first-ever stroke and related prognostic factors in the Perth Community Stroke Study. Stroke 2000;31:2080–2086.
25.
Burstrom K, Johannesson M, Diderichsen F. A comparison of individual and social time trade-off values for health states in the general population. Health Policy 2006;76:359–370.
26.
Samsa GP, Reutter RA, Parmigiani G, et al. Performing cost-effectiveness analysis by integrating randomized trial data with a comprehensive decision model: application to treatment of acute ischemic stroke. J Clin Epidemiol 1999;52:259–271.
27.
Ghatnekar O. The Burden of Stroke in Sweden: Studies on Costs and Quality of Life Based on Riks-stroke, the Swedish Stroke Register [doctoral thesis]. Umeå: Umeå University; 2013.
28.
Earnshaw SR, Jackson D, Farkouh R, Schwamm L. Cost-effectiveness of patient selection using penumbral-based MRI for intravenous thrombolysis. Stroke 2009;40:1710–1720.
29.
Cleemput I, Neyt M, Thiry N, et al. Threshold Values for Cost Effectiveness in Health Care Health Technology Assessment (HTA): KCE Reports 100C (D/2008/10.273/96). Brussels: Belgian Health Care Knowledge Centre (KCE); 2008.
30.
Nogueira RG, Lutsep HL, Gupta R, et al. Trevo versus Merci retrievers for thrombectomy revascularisation of large vessel occlusions in acute ischaemic stroke (TREVO 2): a randomised trial. Lancet 2012;380:1231–1240.
31.
Saver JL, Jahan R, Levy EI, et al. Solitaire flow restoration device versus the Merci Retriever in patients with acute ischaemic stroke (SWIFT): a randomised, parallel-group, non-inferiority trial. Lancet 2012;380:1241–1249.
32.
Riks-Stroke. Årsrapport 2013 [annual report 2013]. Umeå: 2014. Available at: http://www.riksstroke.org/wp-content/uploads/2014/07/Strokerapport_AKUTTIA3man_LR.pdf. Accessed November 25, 2015.
33.
Dewey HM, Thrift AG, Mihalopoulos C, et al. Informal care for stroke survivors: results from the North East Melbourne Stroke Incidence Study (NEMESIS). Stroke 2002;33:1028–1033.

Information & Authors

Information

Published In

Neurology®
Volume 86Number 11March 15, 2016
Pages: 1053-1059
PubMed: 26873954

Publication History

Received: June 25, 2015
Accepted: November 4, 2015
Published online: February 12, 2016
Published in print: March 15, 2016

Permissions

Request permissions for this article.

Disclosure

The authors report no disclosures relevant to the manuscript. Go to Neurology.org for full disclosures.

Study Funding

Supported by grants from the Dental and Pharmaceutical Benefits Agency.

Authors

Affiliations & Disclosures

Mattias Aronsson, MSc
From the Department of Medical and Health Sciences (M.A., L.-Å.L.), Linkoping University; Department of Clinical Neuroscience and Rehabilitation at the Sahlgrenska Academy (J.P., C.B.), University of Gothenburg; Department of Public Health and Clinical Science (P.W.), University of Umea; and Department of Clinical Sciences (P.W.), Danderyd Hospital, Karolinska Institutet, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Dental and Pharmaceutical Benefits Agency, Investigator, 2015.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Josefine Persson, MSc
From the Department of Medical and Health Sciences (M.A., L.-Å.L.), Linkoping University; Department of Clinical Neuroscience and Rehabilitation at the Sahlgrenska Academy (J.P., C.B.), University of Gothenburg; Department of Public Health and Clinical Science (P.W.), University of Umea; and Department of Clinical Sciences (P.W.), Danderyd Hospital, Karolinska Institutet, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Christian Blomstrand, MD, PhD
From the Department of Medical and Health Sciences (M.A., L.-Å.L.), Linkoping University; Department of Clinical Neuroscience and Rehabilitation at the Sahlgrenska Academy (J.P., C.B.), University of Gothenburg; Department of Public Health and Clinical Science (P.W.), University of Umea; and Department of Clinical Sciences (P.W.), Danderyd Hospital, Karolinska Institutet, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Per Wester, MD, PhD
From the Department of Medical and Health Sciences (M.A., L.-Å.L.), Linkoping University; Department of Clinical Neuroscience and Rehabilitation at the Sahlgrenska Academy (J.P., C.B.), University of Gothenburg; Department of Public Health and Clinical Science (P.W.), University of Umea; and Department of Clinical Sciences (P.W.), Danderyd Hospital, Karolinska Institutet, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
1) St Jude Medical, speaker honoraria
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Lars-Åke Levin, PhD
From the Department of Medical and Health Sciences (M.A., L.-Å.L.), Linkoping University; Department of Clinical Neuroscience and Rehabilitation at the Sahlgrenska Academy (J.P., C.B.), University of Gothenburg; Department of Public Health and Clinical Science (P.W.), University of Umea; and Department of Clinical Sciences (P.W.), Danderyd Hospital, Karolinska Institutet, Sweden.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to M. Aronsson: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

M.A.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, and analysis or interpretation of data. J.P.: drafting/revising the manuscript for content, including medical writing for content, and analysis or interpretation of data. C.B.: drafting/revising the manuscript for content, including medical writing for content, and analysis or interpretation of data. P.W.: drafting/revising the manuscript for content, including medical writing for content, and analysis or interpretation of data. L.-Å.L.: drafting/revising the manuscript for content, including medical writing for content, study concept or design, and analysis or interpretation of data.

Metrics & Citations

Metrics

Citation information is sourced from Crossref Cited-by service.

Citations

Download Citations

If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.

Cited By
  1. Cost-effectiveness of endovascular treatment for acute ischemic stroke in China: evidence from Shandong Peninsula, Health Economics Review, 14, 1, (2024).https://doi.org/10.1186/s13561-024-00513-7
    Crossref
  2. Cost-effectiveness of Direct Transfer to Angiography Suite of Patients With Suspected Large Vessel Occlusion, Neurology, 101, 10, (e1036-e1045), (2023)./doi/10.1212/WNL.0000000000207583
    Abstract
  3. Cost-Effectiveness of Endovascular Thrombectomy in M2 Occlusion Stroke: Real-World Experience Versus Clinical Trials, Journal of Endovascular Therapy, (2023).https://doi.org/10.1177/15266028231201098
    Crossref
  4. Optimized density and locations of stroke centers for improved cost effectiveness of mechanical thrombectomy in patients with acute ischemic stroke, Journal of NeuroInterventional Surgery, 16, 2, (156-162), (2023).https://doi.org/10.1136/jnis-2023-020299
    Crossref
  5. Is Mechanical Thrombectomy or Thrombolysis Universally Cost-Effective? A Systematic Review of the Literature, World Neurosurgery, 169, (e29-e39), (2023).https://doi.org/10.1016/j.wneu.2022.09.127
    Crossref
  6. Mechanical Thrombectomy with Intravenous Thrombolysis versus Thrombolysis Alone for the Treatment of Stroke: A Systematic Review of Economic Evaluations, Journal of Vascular and Interventional Radiology, 34, 10, (1749-1759.e2), (2023).https://doi.org/10.1016/j.jvir.2023.06.015
    Crossref
  7. Drivers of Ischemic Stroke Hospital Cost Trends Among Older Adults in the United States, Journal of the American College of Radiology, 20, 4, (411-421), (2023).https://doi.org/10.1016/j.jacr.2022.09.026
    Crossref
  8. Cost-Effectiveness of Endovascular Thrombectomy in Childhood Stroke: An Analysis of the Save ChildS Study, Journal of Stroke, 24, 1, (138-147), (2022).https://doi.org/10.5853/jos.2021.01606
    Crossref
  9. Stroke pathway — An evidence base for commissioning — An evidence review for NHS England and NHS Improvement, NIHR Open Research, 2, (43), (2022).https://doi.org/10.3310/nihropenres.13257.1
    Crossref
  10. Quality of life and cost consequence of delays in endovascular treatment for acute ischemic stroke in China, Health Economics Review, 12, 1, (2022).https://doi.org/10.1186/s13561-021-00352-w
    Crossref
  11. See more
Loading...

View Options

Login options

Check if you have access through your login credentials or your institution to get full access on this article.

Personal login Institutional Login
Purchase Options

The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.

If you need immediate support or to place an order, please call or email customer service:

  • 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
  • 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
  • [email protected]

We appreciate your patience during this time and apologize for any inconvenience.

View options

PDF and All Supplements

Download PDF and Supplementary Material

Full Text

View Full Text

Full Text HTML

View Full Text HTML

Media

Figures

Other

Tables

Share

Share

Share article link

Share