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Mechanical thrombectomy added to thrombolysis cost-effective for acute ischemic stroke
In an analysis of the THRACE trial, mechanical thrombectomy combined with IV thrombolysis within 4 hours of symptom onset was cost-effective compared with IV thrombolysis alone in patients with acute ischemic stroke, accounting for averted cases of disability and quality-adjusted life years.
The cost-effectiveness analysis focused on data from 200 patients with acute ischemic stroke who were randomly assigned to a combined strategy of mechanical thrombectomy and IV thrombolysis and 202 patients assigned to IV thrombolysis alone as part of the randomized, controlled THRACE trial.
“This approach combines the advantages of the two treatments in that intravenous thrombolysis can be started within a short time, whereas endovascular treatment, which requires time to mobilize the interventional team, increases the rate of recanalization,” the researchers wrote.
According to results of the new analysis, the combination strategy was associated with a 10.9% increase in the number of averted disability cases compared with thrombolysis alone (53% vs. 42.1%; P = .028). The findings showed no significant differences between the combination-strategy group and the thrombolysis-only group in mortality (12% vs. 13%; P = .7) or symptomatic intracranial hemorrhage (2% vs. 2%; P = .71).
For this analysis, the researchers considered costs from the perspective of the National Health Insurance System in France. The average cost of implementation of the combination strategy was $2,116 (90% CI, 1,884-2,348). The estimated cost per one averted case of disability was $19,379 (90% CI, 10,576-79,822), which was below the willingness-to-pay threshold of $36,351 in 2015. Additionally, the net monetary benefit was $1,853 (90% CI, –1,205 to 4,911), suggesting the benefits of combination treatment outweighed the cost of implementation.
In other results, the mean quality-adjusted life year (QALY) score was higher by 0.12 years with combination treatment vs. thrombolysis alone, according to the data. The estimated incremental cost per one QALY gained was $14,880 (90% CI, 8,595-47,007), indicating the cost-effectiveness of combination treatment compared with thrombolysis alone. The average incremental net monetary benefit was estimated to be $2,757 (90% CI, –454 to 5,968).
Results of a sensitivity analysis showed the probability of combination therapy being cost-effective was 84.1% in terms of averting disability and 92.2% in terms of QALYs.
“... [I]n terms of the better clinical outcomes with IVMT than IVT at 1 year, we think that differences in health care costs between the strategies would be lower when considering all costs. More precisely, the extra cost caused by thrombectomy as an additional intervention may be offset by less healthcare use in the ambulatory environment. This situation would lead to a lower incremental cost per unit efficacy. Therefore, decisions would favor implementing the new treatment strategy,” the researchers wrote.
Although these data demonstrate the cost-effectiveness of combination therapy, the researchers noted that they only considered costs of implementation and hospital stay in France and also did not account for costs of outpatient care. The study was also limited by attrition bias in cost-utility analysis. – by Melissa Foster
Disclosures: One author reports he received grants from the French Ministry of Health, personal fees from General Electric Medical Systems and nonfinancial support from Microvention Europe. The other authors report no relevant financial disclosures.