Data_Sheet_1.PDF

Abstract

Background To compare the cost-effectiveness of providing endovascular thrombectomy (EVT) for ischemic stroke patients in the >4.5 hour time window between patient groups who do, and do not meet the perfusion imaging trial criteria. Methods A discrete event simulation (DES) model was developed to simulate the long-term outcome of patients post EVT in those meeting or not meeting the extended time window clinical trial perfusion imaging criteria at presentation, versus medical treatment alone (including intravenous thrombolysis). Effectiveness of thrombectomy in patients meeting the landmark trial criteria (DEFUSE 3 and DAWN) was derived from a prospective cohort study of Australian patients who received EVT for ischaemic stroke between 2015 and 2019 in the extended time window (>4.5 hours). Results EVT was shown to be a cost-effective treatment for patients satisfying the clinical trial criteria in our prospective cohort (ICER of $11,608/QALY for DEFUSE 3-postive or $34,416/QALY for DAWN-positive). However, offering EVT to patients outside of clinical trial criteria was associated with reduced benefit (-1.02 QALY for DEFUSE 3; -1.43 QALY for DAWN) and higher long term patient costs ($8,955 for DEFUSE 3; $9,271 for DAWN), making it unlikely to be cost-effective in Australia. Conclusions Treating patients not meeting the DAWN or DEFUSE 3 clinical trial criteria in the extended time window for EVT were associated with less QALYs gained and higher cost. Caution should be exercised when considering this procedure for patients not satisfying the trial perfusion imaging criteria for EVT.