• Joyce S Balami, Diamuid Coughlan, Phil M White, Peter McMeekin, Darren Flynn, Christine Roffe, Indira Natarajan, Jayan Chembala, Sanjeev Nayak, Ivan Wiggam, Peter Flynn, Robert Simister, Yazen Sammaraiee, Don Sims, Kurdow Nader, Anand Dixit, Dawn Craig, Hannah Lumley, Stephen Rice, David Burgess, Lisa Foddy, Emer Hopkins, Beverley Hudson, Rachael Jones, Martin A James, Alastair M Buchan, Gary A Ford, and Alastair M Gray.
• Centre for Evidence-Based Medicine, Oxford, UK and Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK joyce.balami@kellogg.ox.ac.uk.
• Clin Med (Lond). 2020 May 1; 20 (3): e40e45e40-e45.

IntroductionThe clinical efficacy and cost-effectiveness of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke is well established, but uncertainty remains around the true cost of delivering this treatment within the NHS. The aim of this study was to establish the cost of providing MT within the hyperacute phase of care and to explore differences in resources used and costs across different neuroscience centres in the UK.MethodThis was a multicentre retrospective study using micro-costing methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018.ResultsData were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527-11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649-8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381-1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345-2,719; p<0001).The mean cost within 72 hours was £12,440 (95% CI 10,628-14,252). The total costs for the duration of inpatient care before discharge from a thrombectomy centre was £14,362 (95% CI 13,603-15,122).ConclusionsMajor factors contributing to costs of MT for stroke include consumables and staff for intervention, use of general anaesthesia and ICU admissions. These findings can inform the reimbursement, provision and strategic planning of stroke services and aid future economic evaluations.© Royal College of Physicians 2020. All rights reserved.

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