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Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke

Pizzo, E; Dumba, M; Lobotesis, K; (2020) Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke. International Journal of Stroke , 15 (1) pp. 75-84. 10.1177/1747493019830587. Green open access

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Abstract

BACKGROUND: Recently, two randomized controlled trials demonstrated the benefit of mechanical thrombectomy performed between 6 and 24 h in acute ischemic stroke. The current economic evidence is supporting the intervention only within 6 h, but extended thrombectomy treatment times may result in better long-term outcomes for a larger cohort of patients. AIMS: We compared the cost-utility of mechanical thrombectomy in addition to medical treatment versus medical treatment alone performed beyond 6 h from stroke onset in the UK National Health Service (NHS). METHODS: A cost-utility analysis of mechanical thrombectomy compared to medical treatment was performed using a Markov model that estimates expected costs and quality-adjusted life years (QALYs) over a 20-year time horizon. We present the results of three models using the data from the DEFUSE 3 and DAWN trials and evidence from published sources. RESULTS: Over a 20-year period, the incremental cost per QALY of mechanical thrombectomy was $1564 (£1219) when performed after 12 h from onset, $5253 (£4096) after 16 h and $3712 (£2894) after 24 h. The probabilistic sensitivity analysis demonstrated that thrombectomy had a 99.9% probability of being cost-effective at the minimum willingness to pay for a QALY commonly used in the UK. CONCLUSIONS: The results of this study demonstrate that performing mechanical thrombectomy up to 24 h from acute ischemic stroke symptom onset is still cost-effective, suggesting that this intervention should be implemented by the NHS on the basis of improvement in quality of life as well as economic grounds.

Type: Article
Title: Cost-utility analysis of mechanical thrombectomy between 6 and 24 hours in acute ischemic stroke
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/1747493019830587
Publisher version: http://doi.org/10.1177/1747493019830587
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Ischemic stroke, cost-effectiveness, cost-utility, mechanical thrombectomy, thrombolysis
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Epidemiology and Health > Applied Health Research
URI: https://discovery.ucl.ac.uk/id/eprint/10068001
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