• Ajay Malhotra, Artem Boltyenkov, Xiao Wu, Charles C Matouk, Howard P Forman, Dheeraj Gandhi, and Pina Sanelli.
• Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut, USA. Electronic address: ajay.malhotra@yale.edu.
• World Neurosurg. 2020 Jul 1; 139: e23-e31.

BackgroundTwo main techniques for endovascular treatment of patients with acute ischemic stroke are direct aspiration and stent retriever thrombectomy. We hypothesized that the direct aspiration approach would be less costly than the stent retriever approach.MethodsWe constructed a decision tree based on the 2 approaches for endovascular treatment. Branch point probabilities were obtained from the best available, recently published literature. Costs were based on the list prices of medical devices from vendors. From this, we obtained a base-case analysis and conducted sensitivity analysis.ResultsOur base-case analysis revealed that the incremental cost per patient for endovascular treatment was $5937 for direct aspiration-first pass technique and $9914 for stent retriever first pass technique. The cost difference per patient treated was $3977. To drive the stent retriever first pass therapy to be the less costly option, the cost of stent retriever first pass technique has to go down more than 50%. Stent retriever first pass carries lower cost when the success rate of first-line aspiration is lower than 14.6%, which is highly improbable. Two-way sensitivity analysis revealed scenarios in which stent retriever first pass approach would be less costly than the direct aspiration-first pass approach; however, conditions required for these scenarios are rarely encountered in clinical practice.ConclusionsCosts of endovascular treatment using a direct aspiration-first pass approach are less than with a stent retriever first pass approach.Copyright © 2020 Elsevier Inc. All rights reserved.

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