Budget Impact Analysis (BIA) Of Mechanical Thrombectomy In Acute Phase Of Ischemic Stroke (AIS)

Abstract

To estimate financial consequences of reimbursement of mechanical thrombectomy (MT) using a stent retriever in patients with AIS in Poland. Analysis was performed from two perspectives: public payer and public payer + patient in 2-year time horizon (2017-2018). Two scenarios were considered: with and without reimbursement of MT. Target population was defined as patients with AIS eligible for MT who are contraindicated to intravenous tissue plasminogen activator (IV-rt PA) or are treated with IV rt-PA (and MT is added). Size of target population and market share for MT were estimated by compilation of following sources: National Health Found stats on Diagnosis Related Groups (DRG), data from stroke clinical center and clinical expert opinion. Cost data, treatment effectiveness and mortality were also included and data were input in accordance with economic analysis. One-way sensitivity analysis was performed for the key input parameters. All estimations were done with constructed Excel model. Total number of target population is 8,748 in 2017 and 9,792 in 2018. This include all patients treated with IV-rt PA and those with contraindications for IV-rt PA but eligible for MT. In scenario without MT total annual expenditures in 1st and 2nd year will be 151.2 mPLN and 192.1 mPLN from public payer perspective (152.2 mPLN and 195.4 mPLN from public payer + patient). In scenario with MT reimbursement estimated number of patients treated with MT will be 514 in 2017 and 1,150 in 2018. This will result with increase in total expenditures by 22.5 mPLN and 50.3 mPLN in 1st and 2nd year of analysis regardless of perspective. Positive decision of reimbursement of mechanical thrombectomy, using a stent retriever, will bring additional cost incurred by public payer or public payer and patients.