June 03, 2015
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Intra-arterial treatment likely cost-effective for acute ischemic stroke

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Treatment with intra-arterial therapy after IV tissue-type plasminogen activator in patients with acute ischemic stroke appears cost-effective, according to an analysis published in Stroke.

Recent randomized controlled trials, including MR CLEAN, ESCAPE, EXTEND-IA and SWIFT PRIME, have demonstrated that intra-arterial therapy with the latest generation of endovascular thrombectomy devices is associated with dramatically improved outcomes in patients with severe acute ischemic stroke. The researchers undertook an analysis to determine whether the therapy also was cost-effective.

They developed a decision analytic model estimating the lifetime costs and outcomes associated with the additional benefit of intra-arterial therapy administered within 0 to 6 hours of stroke onset compared with IV tissue-type plasminogen activator (tPA) administered within 0 to 4.5 hours of onset alone. The model incorporated data from published literature, the MR CLEAN study and U.S. claims databases.

Michelle H. Leppert, MD, MBA, and colleagues measured outcomes in quality-adjusted life-years (QALYs) and assessed the treatment benefit by calculating the cost per QALY gained, with the threshold for cost-effectiveness defined as $50,000 or less per QALY.

Leppert, from the department of neurology at the University of Colorado, Aurora, and colleagues determined that the addition of intra-arterial therapy to IV tPA administration yielded a lifetime gain of 0.7 QALY and cost an additional $9,911, for a cost of $14,137 per QALY.

When the researchers ran simulations, multiway probabilistic sensitivity analysis predicted cost-effectiveness (≤ $50,000 per QALY) 97.6% of the time.

“[Intra-arterial therapy] is likely cost-effective for patients with anterior circulation strokes and proximal occlusion within the 6-hour window in addition to standard medical therapy,” Leppert and colleagues wrote. “From a societal perspective, we will have to start changing the mindset behind stroke care. Providers can no longer stop at administrating [IV] tPA, but patients with suspected anterior infarcts must also have vessel imaging to see whether they would be a candidate for [intra-arterial therapy]. Furthermore, it will involve widening the network of comprehensive stroke centers so that patients meeting the criteria can have prompt access to [intra-arterial therapy].” – by Erik Swain

Disclosure: The researchers report no relevant financial disclosures.