The Source for Neurovascular News and Education

March 28, 2024


Adding mechanical thrombectomy to IV thrombolysis is likely worth the added cost despite having no impact on mortality, researchers found.

 

The cost of adding mechanical thrombectomy to IV thrombolysis is outweighed by the endovascular therapy’s ability to decrease significant disability and increase quality of life, according to a French study published in the October 2017 issue of Stroke.

“About 130,000 hospitalizations because of ischemic stroke are recorded every year in France,” point out Hamza Achit, PhD (CHRU de Nancy, Vandoeuvre-lès-Nancy, France), and colleagues, noting that “stroke represents the leading cause of nontraumatic acquired disability and the second cause of dementia” for that country. Thus, the researchers sought to better understand the economic implications of stroke care within France’s National Health Insurance System.

In the THRACE (Thrombectomie des Artères Cerébrales) randomized controlled trial, patients with acute ischemic stroke were treated with mechanical thrombectomy combined with IV tPA (n = 200) or IV tPAs alone (n = 202). Patients whose therapy included mechanical thrombectomy had a greater likelihood of achieving functional independence (53.0% vs 42.1%, P = 0.028), but both groups had similar rates of mortality (12% vs 13%, P = 0.70) and symptomatic intracranial hemorrhage (2% vs 2%; P = 0.71)

The cost of adding mechanical thrombectomy to therapy was calculated to be $2,116 (€1,909), and the cost of averting one case of disability was estimated to be $19,379 (€17,480). Finally, the incremental cost per one quality-adjusted life-year gained amounted to $14,881 (€13,423).

Sensitivity analysis revealed that the probability of cost-effectiveness for IV thrombolysis combined with mechanical thrombectomy was 84.1% with regard to averted disability and 92.2% with regard to quality-adjusted life-years.

Expense Worth It Within 4-Hour Window

These findings are based on costs specific to France and thus may not apply in other countries. The authors point out that a similar analysis conducted using US data estimated that the additional cost of mechanical thrombectomy was $10,840. In addition, the current study did not take into account the costs of outpatient care, including medical visits and rehabilitation.

Nevertheless, Achit et al conclude that the addition of mechanical thrombectomy to IV tPA within 4 hours of symptom onset of acute stroke is indeed cost-effective within the context studied, given the degree of reduction in disability and improvement in quality of life. “This result was obtained even though the THRACE trial had the lowest estimation of additional benefit found in the literature,” they write.

 


Source:

Achit H, Soudant M, Hosseini K, et al. Cost-effectiveness of thrombectomy in patients with acute ischemic stroke: the THRACE randomized controlled trial. Stroke. 2017;Epub ahead of print.


Disclosures:

Achit reports no relevant conflicts of interest.