Health budget implications of mechanical thrombectomy for acute ischaemic stroke in Australia.

Abstract

This research evaluates the budget impact of treating acute ischaemic stroke (AIS) using a combination of mechanical thrombectomy (MT) with stent retrievers (SR) and intravenous tissue-plasminogen activator (IV-tPA) in Australia. This study examined the economic impact over five years for a patient cohort based on the number of patients treated with MT+ IV-tPA in Australia 2021, versus treatment with IV-tPA alone. A budget impact (BI) model was developed to project direct medical costs (economic impact) of IV-tPA+ MT with SR vs. Intravenous tissue-plasminogen activator alone over a five-year period (2021-2025 inclusive) from a healthcare perspective. The model is composed of a short-run decision tree model based on a 3-month post-treatment modified Rankin Scale (mRS) from the EXTEND-IA study and a published long-run Markov state transition model. Acute, mid-term and long-term care costs were projected based on anticipated mRS scores from the EXTEND-IA trial. Estimated yearly and cumulative budget impact were reported to indicate the economic impact of the two treatment strategies for AIS in the Australian healthcare system. MT+IV-tPA had a greater budgetary impact than IV-tPA alone, with annual savings starting at Year 1 and continuing through to Year 5. Cost savings of 21% or approximately $36 million can be achieved over five years for the patient cohort treated in Australia in 2021. Each MT procedure performed delivers approximately $3280 in annual health system savings per patient. Treatment of AIS with a combination of MT+IV-tPA generates significant savings in the Australian healthcare system compared with IV-tPA alone.