PMD22 BUDGET IMPACT ANALYSIS OF THE INCORPORATION OF MECHANICAL THROMBECTOMY WITH STENT RETRIEVERS AFTER THROMBOLYSIS IN ISCHEMIC-STROKE WITH LARGE VESSEL OCCLUSION IN THE CHILEAN PUBLIC SECTOR.

Abstract

Ischemic-Stroke (IS) is a prevalent disease, responsible for long-term disability, premature deaths, and high-expenditure in Chile. Available treatments for IS due to Large-Vessel Occlusion (LVO) are Thrombolysis (IV-tPA) and Mechanical Thrombectomy (MT) with stent retrievers. Despite its clinical benefits, MT is not covered in Chile. A Budget-Impact Analysis (BIA) was conducted to estimate the financial impact of adding MT after IV-TPA in Chile. A BIA was carried-out based on a decision tree (5 year-horizon, from the public-payor perspective). The first scenario was defined by an inertial execution of MT for cases undergoing IV-tPA and potential candidates for MT. The second scenario considered a progressive expansion of MT based on international proportions of IV-tPA/MT (0.90). Sources of local costs were Related-Diagnosis Groups (DRGs) out of a sample of homogenous high-complexity public-providers (PP). Local overall-survival stats were applied to estimate the flows of cases leaving the model. The cost for MT -estimated from DRG for the case-mix of non-complicated (22.11%), with complications (47.37%), with major complications (26.32%), and with other IR-DRGs (4.22%)- was CLP$8,508,934. For the first scenario, the historical growth of IV-tPA was projected on a linear-regression over a 5-year horizon (R2=0.8998). Furthermore, a proportion of 0.36 of IV-tPA/MT explored throughout DRGs was applied. For that case-mix, a total expenditure (TE), including complementary costs-drivers, of CLP$9,462MM would be reached by the fifth-year (82.28% corresponding to IV-tPA+MT only). MT accounts for 53.42% of the cost of IV-tPA+MT for all years. Regarding TE, MT accounts for 44.16% (less disability). In the second scenario, the TE in IS with LVO is projected to grow 1.85 times (CLP$20,198MM, of which 89.54% is expended in IV-tPA+MT). When both scenarios are compared, the budget impact is CLP$10,735MM (2.13 times) by the fifth-year, enabling an expansion of 1,066 MT quotas versus the inertial scenario for IS with LVO.