MD3 - Cost-Effectiveness Analysis of Mechanical Thrombectomy With Revive SE® Versus Intravenous Thrombolysis for the Treatment of Acute Ischemic Stroke in China

Abstract

Both intravenous thrombolysis (IVT) and mechanical thrombectomy (MT) were recommended for treating acute ischemic stroke (AIS) by clinical guidelines. ReVive SE® is an innovative MT device with demonstrated clinical value, however, its economic evaluation in China is limited. The study aims to determine the cost-effectiveness of ReVive SE® versus IVT in AIS patients from a payer's perspective in China. A two-part model was developed to estimate the cost-effectiveness of ReVive SE® versus IVT. The short-term part (90 days) was a decision-tree that included three health states based on the modified Rankin Scale (mRS) score after treatment: independence (mRS=0-2), disability (mRS=3-5) and death (mRS=6). The long-term (lifetime) part was a Markov model that included four states: independence, disability, stroke recurrence, and death. Clinical efficacy, utility and cost data were obtained from Chinese ReVive SE® registry study and published literature. The model calculated quality-adjusted life years (QALYs) and total costs per patient. Costs and QALYs were discounted by 3.5% annually. Both one-way sensitivity analysis and probabilistic sensitivity analysis were conducted. The incremental cost-effectiveness ratios (ICERs) for ReVive SE® vs. IVT groups were ¥66,355/QALY, ¥39,062/QALY, and ¥35,305/QALY, respectively for 5-year, 15-year, and lifetime horizon. The ICER became lower than the recommended cost-effectiveness threshold (3 times of gross domestic product per capita, ¥161,940) beginning at the 1 year following the procedure till lifetime. Both one-way and probabilistic sensitivity analysis confirmed the robustness of the results. With the 3 times of gross domestic product threshold, ReVive SE ® is 87.46% cost-effective compared with IVT for lifetime horizon in the model. MT with ReVive SE® is a cost-effective treatment of AIS in China compared to IVT. This evidence supports the broad clinical application of MT with ReVive SE® over IVT. With caregivers’ costs unmeasured, ReVive SE® could be even more cost-effective.