218 Cost-Effectiveness and Quality-Adjusted Life Years Analysis for Endovascular Management of Acute Stroke With a Large Ischemic Region

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INTRODUCTION: Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the infarction is large (defined as ASPECT score of < 5). However, a recent trial (RESCUE-Japan) published in NEJM, showed that patients with large cerebral infarctions had better functional outcomes, measured as mRS of 0-3 at 90 days, with MT compared to best medical management (BMM) alone. METHODS: Treeage, a decision-analytic software, was used to construct a cost effectiveness analysis model that compares the cost-effectiveness of MT vs. BMM alone based on the RESCUE-Japan study. The model includes a short-term decision model that examines costs and clinical outcomes of patients with acute ischemic stroke during the initial three months of treatment. Additionally, a long-term Markov state transition model is created to estimate expected outcomes and costs annually over a 20-year timeframe, with patients potentially experiencing recurrent strokes, transitioning to lower health states, and death from stroke. The success of each treatment was evaluated using QALYs. Then, to assess the robustness of this model, a sensitivity analysis was performed. RESULTS: In the base–case analysis of the total study population using a time horizon of 20 years, MT and BMM alone were found to have a 2.86 QALY and 1.44 QALY, respectively. This increase in the number of QALY by MT came at a lower cost of $275,805 compared to BMM alone, which had a cost $282,476. The incremental cost-effectiveness ratio (ICER) was determined at $-4697/QALY. The results were further supported by the 1-way deterministic and probabilistic sensitivity analyses. CONCLUSIONS: This study shows that, besides having a better clinical outcome, MT was more cost effective and associated with higher QALYs compared to BMM alone, when accounting for health care cost associated with treatment outcome.