Abstract
Background and Purpose: Mechanical thrombectomy (MT) has been recommended for the treatment of nonminor ischemic stroke by national and international guidelines, but cost-effectiveness evidence has been generated for only a few countries using heterogeneous evaluation methods. We estimate the cost-effectiveness of MT across 32 European countries.
Methods: A Markov model was developed to estimate the cost-effectiveness of MT compared with standard care over a 5-year time horizon. Patients with ischemic stroke eligible for MT were identified from 2017 country-specific incidence data. A societal perspective was adopted, including health, social, and informal care costs, and productivity losses. Model outcomes were expressed as quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of findings.
Results: We identified 267 514 ischemic stroke cases that were eligible for MT treatment across 32 European countries. MT was found to be more effective and cheaper than standard care in two-thirds of the countries (21/32) and cost-effective in all but one country (Bulgaria). Across Europe, the intervention was estimated to produce over 101 327 additional quality-adjusted life years (95% uncertainty interval, 65 180–149 085) and cost savings of $981 million (€868 million, 95% uncertainty interval, −1544 to 2564) and of $1.7 billion (€1.5 billion, 95% uncertainty interval, −1.2 to 3.6) in health and social care and societal costs, respectively.
Conclusions: MT is highly likely to be cost-effective compared with standard care across Europe as a whole and in the vast majority of European countries.
Methods: A Markov model was developed to estimate the cost-effectiveness of MT compared with standard care over a 5-year time horizon. Patients with ischemic stroke eligible for MT were identified from 2017 country-specific incidence data. A societal perspective was adopted, including health, social, and informal care costs, and productivity losses. Model outcomes were expressed as quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of findings.
Results: We identified 267 514 ischemic stroke cases that were eligible for MT treatment across 32 European countries. MT was found to be more effective and cheaper than standard care in two-thirds of the countries (21/32) and cost-effective in all but one country (Bulgaria). Across Europe, the intervention was estimated to produce over 101 327 additional quality-adjusted life years (95% uncertainty interval, 65 180–149 085) and cost savings of $981 million (€868 million, 95% uncertainty interval, −1544 to 2564) and of $1.7 billion (€1.5 billion, 95% uncertainty interval, −1.2 to 3.6) in health and social care and societal costs, respectively.
Conclusions: MT is highly likely to be cost-effective compared with standard care across Europe as a whole and in the vast majority of European countries.
Original language | English |
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Pages (from-to) | 664–673 |
Number of pages | 10 |
Journal | Stroke |
Volume | 52 |
Issue number | 2 |
Early online date | 11 Jan 2021 |
DOIs | |
Publication status | Published - Feb 2021 |
Keywords
- thrombectomy
- quality-adjusted life years
- ischemic stroke
- guideline
- Europe
- cost-effectiveness