Cost-Effectiveness of A Direct Aspiration First Pass Technique (ADAPT) For Thrombectomy Revascularization of Large Vessel Occlusion In Acute Ischemic Stroke (French Health Ministry Prme 16-0020)

Abstract

To estimate the cost-effectiveness of Direct Aspiration First Pass Technique (ADAPT) versus mechanical thrombectomy with a Stent Retriever (SR) procedure in acute ischemic stroke from a French healthcare providers perspective. The cost-effectiveness study was carried out from a prospective, randomized and multicenter clinical trial including 8 French hospitals. Medical and costs data were collected prospectively relating to the initial procedure from the onset symptom to the best recanalization. The direct medical costs data were collected by micro-costing and analytical accounting. The primary outcome is the modified score Rankin scale (mRS) of independent at three-months (score 0-2). Economic acceptability for community of this new technique is analyzed by measuring the Incremental Cost-Effectiveness Ratio (ICER). Sensitivity analyses were performed. We include 381 eligible patients (192 allocated to ADAPT and 189 allocated to SR) from October 2015 to October 2016. The mean hospital costs were €8372 in ADAPT group, and €8069 in SR group (p-value = 0.49). The percentage of independent patients at 3 months was 55.17 % in ADAPT group, and 62.06 % in SR group (p-value = 0.23). The resulting ICER reveals the need to invest €4389 in order to achieve an additional percentage of independence with the innovative strategy compared to the standard strategy. Based on randomized trial, we demonstrate that ADAPT is not more efficient compared to SR. We will then consider the cost per QALY (mapping mRS into EQ-5D) at 12-months.