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Acute ischaemic stroke: a systematic review of the cost-effectiveness of emergency endovascular therapy using mechanical thrombectomy

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Abstract

Purpose

Although good evidence exists regarding the clinical effectiveness of mechanical thrombectomy for people with acute ischaemic stroke, cost-effectiveness should also be considered. The aim of this study was to systematically review the evidence of cost-effectiveness of emergency endovascular therapy using mechanical thrombectomy in the management of acute ischaemic stroke.

Methods

The search was carried out in PubMed, EMBASE, Cochrane Library, and a grey literature search. Studies were included if they compared the costs and consequences of mechanical thrombectomy added to usual medical care compared to usual care alone for people with acute ischaemic stroke in the anterior and/or posterior region. Study quality was assessed using two appraisal tools tailored to economic evaluations.

Findings

Thirteen studies were identified including twelve cost-utility analyses and one cost-benefit analysis. Studies could be dichotomised into those that evaluated first-generation (n = 4) and second-generation (n = 9) mechanical thrombectomy devices. Six studies had low applicability, six had moderate applicability, and one had high applicability to other settings. All cost-utility studies reported incremental cost-effectiveness ratios that would be considered cost-effective under typical willingness-to-pay thresholds.

Conclusions

If the outcomes of the trials underpinning the evidence of clinical effectiveness can be replicated, then mechanical thrombectomy is likely to be cost-effective by typical willingness-to-pay thresholds. This finding holds under the assumption that no investment is required to develop stroke centres to the standard required to provide a safe emergency endovascular service and that additional expenditure on timely patient transport is not required.

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Authors and Affiliations

  1. Health Information and Quality Authority, George’s Court, George’s Lane, Dublin, D07 E98Y, Ireland

    Conor Teljeur, Patricia Harrington, Ronan W. Glynn & Máirín Ryan

  2. Trinity College Dublin, Dublin, Ireland

    Conor Teljeur, Patricia Harrington & Máirín Ryan

Authors
  1. Conor Teljeur
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  2. Patricia Harrington
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  3. Ronan W. Glynn
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  4. Máirín Ryan
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Correspondence to Conor Teljeur.

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Teljeur, C., Harrington, P., Glynn, R.W. et al. Acute ischaemic stroke: a systematic review of the cost-effectiveness of emergency endovascular therapy using mechanical thrombectomy. Ir J Med Sci 188, 751–759 (2019). https://doi.org/10.1007/s11845-018-1946-3

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  • DOI: https://doi.org/10.1007/s11845-018-1946-3

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