Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke

Without looking in detail at how patients were selected this may not be a valid conclusion. I suspect only smaller strokes were selected, cherry picking.
http://stroke.ahajournals.org/content/early/2016/12/27/STROKEAHA.116.014735

Results From the SWIFT-PRIME Trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke)

Theresa I. Shireman, Kaijun Wang, Jeffrey L. Saver, Mayank Goyal, Alain Bonafé, Hans-Christoph Diener, Elad I. Levy, Vitor M. Pereira, Gregory W. Albers, Christophe Cognard, Werner Hacke, Olav Jansen, Tudor G. Jovin, Heinrich P. Mattle, Raul G. Nogueira, Adnan H. Siddiqui, Dileep R. Yavagal, Thomas G. Devlin, Demetrius K. Lopes, Vivek K. Reddy, Richard du Mesnil de Rochemont, Reza Jahan, Katherine A. Vilain, John House, Jin-Moo Lee, David J. Cohen

https://doi.org/10.1161/STROKEAHA.116.014735

Stroke. 2016;STROKEAHA.116.014735

Originally published December 27, 2016

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Abstract

Background and Purpose—Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions.

Methods—In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors.

Results—Index hospitalization costs were $17 183 per patient higher for SST+tPA than for tPA ($45 761 versus $28 578; P<0.001), driven by initial procedure costs. Between discharge and 90 days, costs were $4904 per patient lower for SST+tPA than for tPA ($11 270 versus $16 174; P=0.014); total 90-day costs remained higher with SST+tPA ($57 031 versus $44 752; P<0.001). Higher utility values for SST+tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P=0.005). In lifetime projections, SST+tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of $23 203 per patient and was economically dominant when compared with tPA in 90% of bootstrap replicates.

Conclusions—Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial, SST increased initial treatment costs, but was projected to improve quality-adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA.

Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT01657461.