Endovascular thrombectomy in patients with large core ischemic stroke: a cost-effectiveness analysis from the SELECT study

Mark J Dannenbaum ,Ronald F Budzik,Clark Sitton ,James C Grotta ,Nirav Vora ,Deep Pujara ,Spiros Blackburn,Kyriakos Lobotesis,Arthur L Day ,Select Investigators ,Ameer E Hassan ,Gregory W Albers ,Anjail Sharrief ,Rishi Gupta,William Hicks,Maarten G Lansberg,Sheryl Martin‐Schild ,Wolfgang G Kunz ,Elena Pizzo,Michael Abraham ,Amrou Sarraj

doi:10.1136/neurintsurg-2020-016766

Abstract

BackgroundIt is unknown whether endovascular thrombectomy (EVT) is cost effective in large ischemic core infarcts.MethodsIn the prospective, multicenter, cohort study of imaging selection study (SELECT), large core was defined as...

Highlights

Stroke is a global health problem, with more than 13 million new strokes and 5.5 million deaths every year[1]
Study population: “The Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT): a Prospective Multicenter Cohort Study of Imaging Selection”[22] enrolled patients with stroke attributable to large-vessel occlusion who were treated with endovascular thrombectomy plus medical management or medical management alone, based on CT or CTP findings, up to 24 hours from the point that they were last known to be well at 9 comprehensive stroke centers across the United States
Functional Outcomes in Patients with Large Ischemic Core Infarcts: Of 361 patients enrolled in SELECT, 105 (29%) had a large ischemic core on CT or CTP or both (EVT 62, MM 43)

Summary

Introduction

Stroke is a global health problem, with more than 13 million new strokes and 5.5 million deaths every year[1]. Whether endovascular thrombectomy (EVT) is cost-effective in large ischemic core infarcts is unknown. A Markov model estimated costs, quality-adjusted life years (QALYs) and the incremental costeffectiveness ratio (ICER) of EVT compared to medical management (MM) over life time. Results: From a prospective cohort trial of 361 patients, 105 had large core on CT or CTP (EVT 62, MM 43). Over the projected lifetime of stroke patients presenting with large ischemic core, EVT was associated with incremental costs of $33,094 and a gain of 1.34 QALYs per patient, resulting in ICER of $24,665 per QALY. Conclusion: EVT may result in better outcomes in large core patients with higher QALYs, NMB and high cost-effectiveness acceptability rates based on current WTP thresholds.

Methods

Results

Conclusion