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A systematic review of cost-effectiveness analyses on endovascular thrombectomy in ischemic stroke patients

  • Health Economy
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An Editorial Comment to this article was published on 31 March 2022

Abstract

Objective

The objective of this study was to examine the published cost-effectiveness analyses (CEAs) on endovascular thrombectomy (EVT) in acute stroke patients, with a particular focus on the practice of accounting for costs and utilities.

Methods

We conducted a systematic review of published CEAs on EVT in acute stroke patients from 1/1/2009 to 10/1/2019. Published CEAs were searched in Ovid Embase, Ovid MEDLINE, and Web of Science. Cost or comparative effectiveness analyses were excluded. Risk of bias and quality assessment was based on the Consolidated Health Economic Evaluation Reporting Standard checklist.

Results

Twenty-one studies were included in the final analysis, from the USA, Canada, Europe, Asia, and Australia. They all concluded EVT to be cost-effective, but with significant variations in methodology. Fifteen studies employed a long-term horizon (> 20 years), while only 11 incorporated risk of recurrent strokes. The willingness-to-pay (WTP) threshold varied from $10,000/quality-adjusted life year (QALY) to $120,000/QALY, with $50,000/QALY and $100,000/QALY being the most commonly used. Five studies undertook a societal perspective, but only one accounted for indirect costs. Seventeen studies based outcomes on 90-day modified Rankin Scale (mRS) scores, and 9 of these 17 studies grouped outcomes by mRS 0–2 and 3–5. Among these 9 studies, the range of QALY score reported for mRS 0–2 was 0.71–0.85 QALY, and that of mRS 3–5 was 0.21–0.40.

Conclusions

Our study reveals significant heterogeneity in previously published thrombectomy CEAs, highlighting need for better standardization in future CEAs.

Key Points

• All included studies concluded thrombectomy to be cost-effective, from both long- and short-term perspectives.

• Only 5 out of 22 studies undertook a societal perspective, and only 1 accounted for indirect costs.

• The range of value for mRS 0–2 was 0.71–0.85 quality-adjusted life year (QALY) and 0.21–0.40 QALY for mRS 3–5.

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Abbreviations

CEA:

Cost-effectiveness analysis

EVT:

Endovascular thrombectomy

ICER:

Incremental cost-effectiveness analysis

IVT:

Intravenous thrombolysis

LVO:

Large-vessel occlusion

mRS:

Modified Rankin scale

PRISMA:

Preferred Reporting Items for Systematic review and Meta-Analysis

QALY:

Quality-adjusted life year

TICI:

Thrombolysis in cerebral infarction

WTP:

Willingness to pay

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiology and Biomedical Imaging, University of California at San Francisco, San Francisco, CA, USA

    Xiao Wu

  2. Department of Radiology and Biomedical Imaging, Yale School of Medicine, Box 208042, Tompkins East 2, 333 Cedar St, New Haven, CT, 06520-8042, USA

    Mihir Khunte & Ajay Malhotra

  3. Diagnostic Radiology and Nuclear Medicine, Neurology and Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA

    Dheeraj Gandhi

  4. Northwell School of Medicine at Hofstra University, 500 Hofstra Blvd, Hempstead, NY, 11549, USA

    Pina Sanelli

  5. Department of Radiology and Biomedical Imaging, of Economics, of Management, and of Public Health, Yale University School of Medicine, New Haven, CT, USA

    Howard P. Forman

Authors
  1. Xiao Wu
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  2. Mihir Khunte
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  3. Dheeraj Gandhi
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  4. Pina Sanelli
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  5. Howard P. Forman
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  6. Ajay Malhotra
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Correspondence to Ajay Malhotra.

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The scientific guarantor of this publication is Ajay Malhotra.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Institutional Review Board approval was not required because it is a systematic review of published literature.

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Wu, X., Khunte, M., Gandhi, D. et al. A systematic review of cost-effectiveness analyses on endovascular thrombectomy in ischemic stroke patients. Eur Radiol 32, 3757–3766 (2022). https://doi.org/10.1007/s00330-022-08671-0

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