Title : Economic impact of the first pass effect in mechanical thrombectomy for acute ischaemic stroke treatment
Abstract:
Objective:
The clinical benefit of mechanical thrombectomy(MT) in acute ischemic stroke treatment, is correlated to the degree of reperfusion achieved. The First Pass Effect (FPE) is defined as complete/near revascularisation of the large-vessel occlusion [modified Thrombolysis in Cerebral Infarction (mTICI)2c-3] after a single device pass. FPE can potentially be one of the primary goals in the treatment of ischemic stroke due to large vessel occlusion (LVO)from a clinical and economic viewpoint.
Methods:
The model simulates a hypothetical cohort of 1000 patients with clinic-demographics characteristics based on the STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischaemic Stroke). STRATIS registry patients were classified into 2 groups: patients with a final mTICI ≥2b (used for the base case analysis), and patients with final mTICI (0–3) (used for the alternative scenario). Afterwards, patients in both groups were stratified into FPE and non-FPE groups.
The model had a two-phase structure, consisting of an acute-subacute phase from stroke onset to 90 days, and a rest-of-life phase 91 days after stroke to the end of patient’s life.
Results:
Our results suggest that the FPE group had significantly better clinical outcomes at 90 days after stroke compared with the non-FPE group in the base case scenario (mRS 0–2: 66.2% vs 54.6%, p<0.005) and in the alternative scenario (mRS 0–2: 66.9% vs 50.6%, p<0.0001). In the base case scenario, the model estimates an average lifetime cost per patient of €97,206 for the FPE group and €113,790 for the non-FPE group. Overall, the FPE group generated a cost reduction of €16,583 per patient in a lifetime horizon. Cost reductions are predicted to be greater when nursing/residential care cost are included, leading to a savings of €30,072 per patient. The alternative scenario results in a cost reduction per patient of €21,910 was estimated and a further reduction of €44,289 when nursing/residential costs are considered. In terms of health outcomes, achieving FPE results in an incremental QALY gain of 1.2 and 1.75 in the alternative scenario .
Conclusion:
Acute ischemic stroke patients treated with neurothrombectomy devices and who achieved FPE after MT showed significantly better functional clinical outcomes and were associated with important healthcare cost saving per patient compared with who did not achieved FPE.
