Abstract WP50: Cost-Effectiveness of Mechanical Thrombectomy for Acute Ischemic Stroke: An Analysis From RESILIENT Trial

Abstract

Background and purpose: RESILIENT Trial was the first study in a developing country to demonstrate the benefit of mechanical thrombectomy (MT) in acute stroke patients. This economic evaluation aimed to access the cost-utility of MT under the perspective of the Brazilian Public Healthcare System. Methods: Analysis was based on a subset sample of the original study (151 of 221 patients) from 4 hospitals. We compared costs and utilities between MT plus standard care (n=78) vs. standard care alone (n=73). Direct medical costs were considered, and utilities were inputted according to each patient’s Utility-Weighted modified Rankin Score (UW-mRS). First-year survival was obtained from trial follow-up and modelled for a life-time horizon adjusted by National Mortality Data. Direct medical costs were converted to I$ using Purchasing Power Parity (PPP). A discount rate of 5% was used. Incremental cost-effectiveness ratio (ICER) is expressed in cost (I$) per Quality-Adjusted Life Year (QALY). Results: RESILIENT trial was stopped on its first interim analysis because of early efficacy. The incremental costs and QALYs gained with MT were estimated at I$ 8,369 and 0.75, respectively, compared with standard medical care, yielding an incremental cost-effectiveness ratio (ICER) of I$ 7,256 per QALY. Conclusion: The initially higher costs of MT were offset by the clear benefit of the intervention. RESILIENT trial demonstrated that such therapy is likely to be cost-effective despite the economical constraints in the Brazilian healthcare system.

Mechanical Thrombectomy Global Access For Stroke (MT-GLASS): A Mission Thrombectomy (MT-2020 Plus) Study

“…Despite high upfront cost of the MT procedure and devices, it has been shown to be cost-effective from both a societal and a health care system perspective 98–101 in HIC as well as middle-income countries and in the <6-hour and the 6- to 24-hour treatment window. 102–104 In LMIC, health financing systems rely heavily on out-of-pocket payments, which can put a tremendous burden on households, increasing the risk of catastrophic (defined as payments >25% of the total household budget) or impoverishing (when payments push a household’s other spending below a minimum socially recognized living standard) expenditures. 105…”

“…Despite high upfront cost of the MT procedure and devices, it has been shown to be cost-effective from both a societal and a health care system perspective [98][99][100][101] in HIC as well as middle-income countries and in the <6-hour and the 6-to 24-hour treatment window. [102][103][104] In LMIC, health financing systems rely heavily on out-of-pocket payments, which can put a tremendous burden on households, increasing the risk of catastrophic (defined as payments >25% of the total household budget) or impoverishing (when payments push a household's other spending below a minimum socially recognized living standard) expenditures. 105 To improve MT access in regions around the world, the MT2020+ campaign through the local MT2020+ regional committees and often in collaboration with local, national, and international stroke and interventional societies advocate with policymakers to optimize thrombectomy systems of care, insurance reimbursement, and prehospital systems for stroke triage.…”