Delays in thrombectomy contribute to reduced life span in stroke

For each minute thrombectomy is delayed in a patient with acute ischemic stroke, life span, quality of life and cost-effectiveness of care are decreased, researchers reported at the Society of NeuroInterventional Surgery Annual Meeting.

“This study shows that time delays can have a significant impact on a patient and society,” presenter Wolfgang G. Kunz, MD, radiology resident at Ludwig-Maximilians-University in Munich, said in a press release. “Significant time delays of on average 2 hours could be prevented in triage if EMS send patients with severe signs of stroke directly to a comprehensive or level 1 stroke center that provides [endovascular thrombectomy] instead of the closest primary stroke center.”

Kunz and colleagues constructed a Markov model from patients in the HERMES collaboration to determine health and cost consequences of delays in endovascular therapy for patients with acute ischemic stroke with large vessel occlusion.

For each 10-minute treatment delay, there was a loss of 39 days on average of disability-free life per patient, Kunz and colleagues found.

The economic value of care is represented by the parameter net monetary benefit, which accounts for the amount of quality-adjusted life years (QALYs) gained and the costs that are needed to achieve these QALYs (lower net monetary values represent lesser value of care), according to the researchers.

In thrombectomy for stroke, each 10 minutes of delayed treatment decreased the net monetary benefit by $10,593 per patient from a health care perspective and by $10,915 per patient from a societal perspective, Kunz and colleagues calculated.

“Given the dramatic financial benefits to health care systems by increasing efficiency, there should now be greater impetus toward investment into processes and technologies that reduce onset to reperfusion times,” Mayank Goyal, MD, FRCPC, chair of the HERMES collaboration and neurointerventionalist at University of Calgary, said in the release. – by Erik Swain

Reference:

Kunz WG, et al. Lifetime quality of life and cost consequences of treatment delays in endovascular thrombectomy for stroke based on HERMES data. Presented at: Society of NeuroInterventional Surgery Annual Meeting; July 23-26, 2018; San Francisco.

Disclosure: The HERMES collaboration was funded by an unrestricted research grant from Medtronic to the University of Calgary. The authors report no relevant financial disclosures.