PCV37 Cost-Effectiveness Analysis of IV-TPA Followed By Mechanical Thrombectomy with Stent-Retriever Versus IV-TPA ALONE in the Treatment of ACUTE Ischemic Stroke Due to Large Vessel Occlusion in Portugal

Abstract

Report a cost-effectiveness analysis comparing IV-tPA followed by mechanical thrombectomy with stent-retriever versus IV-tPA alone in the treatment of acute ischemic stroke due to large vessel occlusion. A lifetime Markov Model was developed to compare the impact of each ischemic stroke treatment over time in terms of costs and health outcomes (life years gained and QALY) defined by the Modified Ranking Scale in a Portuguese scenario. Clinical data was obtained from SWIFT PRIME trial and additional literature. Resource consumption was obtained from an expert panel and unitary cost were taken from official databases and legislation. Portuguese NHS perspective was considered. Costs are expressed in euros for the year of 2018 and an annual discount rate of 5% was applied on costs and consequences. Sensitivity analyses (deterministic and probabilistic) and alternative scenarios were performed. IV-tPA + stentriever resulted in a more effective and less costly alternative in the base-case scenario considering a lifetime horizon. IV-tPA treatment followed by stentriever versus IV-tPA alone resulted in an incremental cost of -8,723 €, an incremental QALY of 1.96 and incremental life years of 1.80, resulting in a dominant ICER and an net monetary benefit of 67,583 € considering the willingness-to-pay threshold of 30 000 €/QALY. The mechanical thrombectomy after intravenous thrombolysis with IV-tPA is the dominant option for the treatment of acute ischemic stroke due to large vessel occlusion and has the potential to reduce long-term costs and improve patient’s quality of life.