Opportunities to Improve the Cost Effectiveness of the Care Pathway in Acute Ischemic Stroke: A Decision Tree Analysis

OBJECTIVES: An ischemic stroke is one of the leading causes of death and disability in US and Europe. A multitude of innovations are under development to improve the health outcomes in acute ischemic stroke. The aim of this study was to estimate the relative importance of opportunities to improve health economic outcomes in acute ischemic stroke.

METHODS: A decision tree was constructed that included chance nodes for transportation (fast<2 hrs. or otherwise), diagnostic triaging (fast <1 hrs. or otherwise), treatment (EVT or non-EVT <1 hr.), and clinical outcomes (mRS 0-2 or mRS 3-5 or Death). The decision tree was populated with US real-world data as well as health economic evidence from clinical trials. Opportunities to improve the cost-effectiveness of the care pathway were identified through a one-way sensitivity analysis on inputs.

RESULTS: The ICER was most sensitive to 1) increasing the proportion of patients that are eligible for EVT to actually receive EVT; followed by 2) increasing the effectiveness of non-EVT; 3) increasing the effectiveness of EVT; and 4) reducing time to treatment.

CONCLUSIONS: The insights gained help to shape an innovation strategy that is meaningful in improving care for patients suffering from an acute ischemic stroke.