• Mattias Aronsson, Josefine Persson, Christian Blomstrand, Per Wester, and Lars-Åke Levin.
• 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. mattias.aronsson@liu.se.
• Neurology. 2016 Mar 15; 86 (11): 1053-9.

ObjectiveTo evaluate the cost-effectiveness of adding endovascular thrombectomy to standard care in patients with acute ischemic stroke.MethodsThe 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.ResultsThe 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.ConclusionsAdding 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.© 2016 American Academy of Neurology.

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