Endovascular thrombectomy is cost-effective in acute basilar artery occlusion stroke

 I don't think stroke survivors give a flying fuck about cost effectiveness. I think if you talk to them, they want to know your 100% full recovery statistics.

WILL YOU GET WITH THE PROGRAM?

Endovascular thrombectomy is cost-effective in acute basilar artery occlusion stroke

Julian Schwarting^1,2*, Sebastian Rühling¹, Jannis Bodden¹, Stéphanie K. Schwarting³, Claus Zimmer¹, Dirk Mehrens⁴, Jan S. Kirschke¹, Wolfgang G. Kunz⁴, Tobias Boeckh-Behrens^1† and Matthias F. Froelich^5†

• ¹Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany
• ²Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
• ³Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
• ⁴Department of Radiology, University Hospital, LMU Munich, Munich, Germany
• ⁵Department of Radiology and Nuclear Medicine, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany

Objective: Endovascular thrombectomy is a long-established therapy for acute basilar artery occlusion (aBAO). Unlike for anterior circulation stroke, cost-effectiveness of endovascular treatment has not been evaluated and is urgently needed to calculate expected health benefits and financial rewards. The aim of this study was therefore to simulate patient-level costs, analyze the economic potential of endovascular thrombectomy in patients with acute basilar artery occlusion (aBAO), and identify major determinants of cost-effectiveness.

Methods: A Markov model was developed to compare outcome and cost parameters between patients treated by endovascular thrombectomy and patients treated by best medical care, based on four recent prospective clinical trials (ATTENTION, BAOCHE, BASICS, and BEST). Treatment outcomes were derived from the most recent literature. Uncertainty was addressed by deterministic and probabilistic sensitivity analyses. Willingness to pay per QALY thresholds were set at 1x gross domestic product per capita, as recommended by the World Health Organization.

Results: Endovascular treatment of acute aBAO stroke yielded an incremental gain of 1.71 quality-adjusted life-years per procedure with an incremental cost-effectiveness ratio of $7,596 per QALY. This was substantially lower than the Willingness to pay of $63,593 per QALY. Lifetime costs were most sensitive to costs of the endovascular procedure.

Conclusion: Endovascular treatment is cost-effective in patients with aBAO stroke.

Introduction

Stroke remains the leading cause of long-term disability worldwide and the second most common cause of death despite significant advances in therapy (1). A severe subtype of stroke is acute basilar artery occlusion (aBAO) which accounts for approximately 10% of ischemic strokes caused by intracranial large-vessel occlusion (2).

Affected patients suffer in up to 80% from severe disability or die, despite best medical care (3). Although many patients have been treated by endovascular thrombectomy (EVT) even before it became a standard therapy for the anterior circulation, there have been no prospective randomized trials showing the benefit of endovascular thrombectomy in patients with aBAO until recently (2–4).

Four multicenter, prospective, randomized, controlled trials of endovascular thrombectomy for aBAO were published in 2019–2022: ATTENTION (3), BAOCHE (5), BASICS (6), and BEST (7). Despite regional biases and a heterogeneity in outcome, time windows and thrombolysis rates, these trials provide high-level evidence for improvement of functional outcomes and independence in patients treated with EVT (8).

Cost-effectiveness of EVT after large-vessel occlusions in the anterior circulation was extensively investigated and results in long-term cost-savings for healthcare systems and societies, for instance in the United States, where estimated cost savings are approximately $40 billion/year and are predicted to increase substantially within the next decade (9–12).

To our knowledge, there is no evidence of cost-effectiveness of endovascular thrombectomy for acute basilar artery occlusion. As these data are urgently needed to calculate expected health benefits and financial rewards, for instance for further developments of endovascular treatments, we defined and quantified public health and cost consequences of endovascular treatments for aBAO stroke patients and healthcare systems based on the recent literature.

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