It is well established that stroke patients with large vessel occlusions benefit from endovascular thrombectomy (EVT), even beyond six hours of symptom onset. But is EVT cost-effective? That is the question asked – and answered – by a joint study conducted at Ludwig-Maximilians-Universität Munich, Germany, and the University of Calgary, Alberta, Canada.
"Despite EVT incurring additional costs early, our analysis clearly shows that the lifetime costs incurred by treatment of stroke patients were lower when EVT had been performed," said Wolfgang G. Kunz, MD, PhD, a radiology attending at the university hospital of Ludwig-Maximilians-Universität Munich, who spoke at a Tuesday session. "In terms of health economics, this finding represents a dominant strategy, with EVT improving outcomes and saving costs in the long-run."
The study utilized the AURORA meta-analysis (Analysis of Pooled Data from Randomized Studies of Thrombectomy More than 6 hours After Last Known Well). This analysis included patients presenting with large vessel occlusion stroke beyond six hours of symptom onset or last known to be well. The patients were randomized to EVT or medical management.
"Stroke patients with large vessel occlusions benefit from EVT even beyond six hours of symptom onset, as demonstrated by the AURORA meta-analysis of five pooled trials," Dr. Kunz said. "We aimed to determine the cost-effectiveness of EVT within this context."
Using a decision model based on Markov simulations, researchers were able to estimate the lifetime costs and quality-adjusted life years (QALY) associated with EVT or medical management. Based on outcome data of 458 patients randomized within the AURORA meta-analysis, the study identified EVT as the strategy resulting in incremental QALYs and cost-savings over the projected lifetime compared to medical management.
Based on these findings, researchers concluded that EVT provides both considerable long-term clinical benefits and long-term cost savings in the management of patients with large vessel occlusion stroke presenting beyond six hours of symptom onset or last known to be well.
Opening the time window beyond six hours dramatically increases EVT eligibility among stroke patients and leads to increasing demand – and acute care costs. However, according to Dr. Kunz, based on the projected health and cost benefits, health care investments are justified to cover this new demand.
"Thrombectomy is a very powerful treatment in extended time windows and provides a real opportunity to also save long-term costs in stroke care," he says. "And our data clearly justifies health care policies aimed at developing radiology services capable of meeting this demand."