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Endovascular therapy after ischemic stroke reduces costs
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After ischemic stroke due to large vessel occlusion, the addition of endovascular therapy with mechanical thrombectomy to IV tissue plasminogen activator reduced costs and improved quality of life, according to results of two studies presented at the International Stroke Conference.
Bruce C.V. Campbell, MD, from the department of neurology at Royal Melbourne Hospital, Victoria, Australia, and colleagues examined the effects of endovascular therapy after alteplase vs. alteplase alone on cost in the EXTEND-IA trial. EXTEND-IA included 70 patients with severe ischemic stroke that included major vessel occlusion; 35 patients received only alteplase within 4.5 hours of symptom onset while the other 35 patients also underwent mechanical thrombectomy with a stent retriever (Solitaire FR, Covidien). The patients’ mean age was 69 years and the median NIH Stroke Scale score was 15.
Bruce C.V. Campbell
At 3 months, the median disability adjusted weighted utility score based on the modified Rankin scale increased to 0.65 in the alteplase-only group and increased to 0.91 in the thrombectomy group (unadjusted P = .005; adjusted P = .02). Patients who received thrombectomy and alteplase had an increased modeled life expectancy of 12.6 years compared with 7.4 years compared with patients who receive alteplase only (unadjusted P = .048; adjusted P = .046). The addition of thrombectomy also reduced lifetime disability adjusted life-years lost (median, 5.5 vs. 8.9; P = .02) and increased quality adjusted life-years gained (median, 7.5 vs. 4; P = .03). The median length of hospitalization was 5 days for the thrombectomy group vs. 8 days for the alteplase-only group (P = .04). These patients less often required rehabilitation, whereas patients assigned alteplase only had an average rehabilitation time of 27 days.
These findings were associated with reduced costs of inpatient care during the first 3 months: $12,188 vs. $26,112 (P = .009), which overall saved $2,417 per patient after $11,507 transportation and thrombectomy procedural costs, according to the abstract.
In a second study, Mohammad Moussavi, MD, of the Stroke and Neurovascular Center at JFK Medical Center, Edison, New Jersey, and colleagues performed a meta-analysis of six multicenter, prospective randomized control trials comparing outcomes among 1,386 patients with acute large-vessel ischemic stroke who received IV tissue plasminogen activator (tPA) and mechanical thrombectomy or tPA alone.
According to results presented at ISC 2016, 46% of the 688 patients treated with thrombectomy and tPA were deemed independent, according to the modified Rankin scale (score, 0-2), compared with 27% of the 698 patients treated with tPA alone (P = .001). The researchers calculated a number needed to treat of 5.1 for patients assigned thrombectomy and tPA. According to the researchers, this translated to 271 more patients becoming independent after treatment.
The estimated average hospital cost for independent patients after thrombectomy and tPA was $20,396, while the average cost for patients deemed disabled according to the modified Rankin scale was $55,494. According to Moussavi and colleagues, “a cost-savings of $14,613,790 would have been achieved if all patients underwent thrombectomy along with IV tPA.” – by Tracey Romero
References:
Campbell B, et al. Abstract 3.
Moussavi M, et al. Poster WMP12. Both presented at: International Stroke Conference; Feb. 16-19, 2016; Los Angeles.
Disclosures: The EXTEND-IA trial was funded by National Health and Medical Research Council of Australia, Royal Australasian College of Physicians, Royal Melbourne Hospital Foundation, Covidien (Medtronic); Campbell reports receiving research grants for the conduct of the EXTEND-IA trial. Moussavi and colleagues report no relevant financial disclosures.