OBJECTIVES: Mechanical thrombectomy (MT) is a treatment for acute ischemic stroke (AIS). The clinical effect of MT for AIS patients suffering a large-vessel occlusion, is highly time-dependent. Patients admitted to a primary stroke center (PSC) currently must be transferred to a comprehensive stroke center (CSC) for a MT. A remote robotic MT system has the potential to disrupt the acute stroke care pathway by allowing the performance of MT at a PSC by an interventional radiologist physically located in a CSC.

METHODS: We developed a discrete event simulation (DES) model to simulate the stroke treatment of AIS patients to evaluate the short term costs and quality-adjusted life-years (QALY) within the first 90 days. Cost components included in the model were acute care costs and treatment procedure costs. No long term or chronic care costs were included. We performed probabilistic sensitivity analyses (PSA) to assess the uncertainty of model results.

RESULTS: Baseline results indicated that in the short term remote robotic MT is both more costly (by $1,259) and more effective (by 0.01 QALY) than patient transfer from PSC to CSC for MT procedure, corresponding to incremental cost-effectiveness ratio (ICER) of $148,202. In the 10,000 1-st order simulation trials the remote robotic MT strategy led to 2% (31/1521) fewer deaths, 1.8% (62/3533) more functionally independent patients (modified Rankin Score (mRS) 0-2 at 90 days), and 0.6% (31/4946) fewer functionally dependent patients (mRS 3-5 at 90 days). Robotic MT was cost-effective in 5% and 53% of PSA iterations using cost-effectiveness threshold of $100,000/QALY and $150,000/QALY, respectively.

CONCLUSIONS: Remote robotic MT saves lives, increases the number of patients with functional independence, and decreases the number of patients with functional dependence. If only the short term cost and health effects are considered, the ICER is above the $100,000 threshold, but below the $150,000 threshold.