Abstract
The National Institute for Health and Care Excellence (NICE) recommends mechanical clot retrieval (MCR) for the treatment of acute ischemic stroke (AIS). Recently, a large clinical trial in AIS patients treated with a dual-layer stent retriever (DLSR) reported excellent functional independence outcomes, an important goal of stroke therapy that impacts patient quality of life. While the clinical benefits of MCR have been demonstrated, studies assessing the economic implications of technology selection are limited. Thus, this study estimated the budget impact of adopting a DLSR for patients with AIS from a 12-month National Health Service (NHS) perspective. The analysis compared a cost scenario considering a DLSR to a scenario with single-layer stent retrievers only, assuming a 25% adoption rate of DSLR. Acute (90-day) healthcare costs based on patient functional independence measured using the modified Rankin Scale (mRS) were included. Index procedure costs were limited to the acquisition cost of MCR technology, as evidence indicates other procedural resources to be similar between MCR devices. Functional outcomes, acute costs per mRS, and MCR technology acquisition costs were obtained from peer-reviewed literature. Case volume, treatment mix, and cost of the DLSR were obtained from market research data. Costs were reported as 2018 GBP. Among 655 patients treated with MCR over 12 months, 246 patients achieved good functional outcomes (mRS 0-2) in the scenario without the DLSR, compared with 294 patients in the scenario with the DLSR. Total 90-day costs in the scenario with the DLSR were £401,738 lower than the scenario with the DLSR (£10,127,235 vs. £10,528,973). In this analysis, adoption of a DLSR for AIS was associated with improvements in patient functional status. Functional independence may be achieved in 20% more patients in a scenario with the DLSR , which may translate to cost-savings for the NHS.
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