OBJECTIVES : Mechanical thrombectomy (MT) is guideline recommended to treat acute ischemic stroke. The adoption of a dual-layer stent retriever (DLSR) (EMBOTRAP^®, Cerenovus) in MT has recently been evaluated in a budget impact analysis incorporating clinical outcomes from a performance goal-based single-arm study and the corresponding RCTs. It was conducted from the perspective of NHS England. Here, we evaluate the transferability into French and Swedish health care systems.

METHODS : The model compared economic impact of increased adoption of DLSR from the hospital´s perspective of France (DLSR: 2.0% to 9%) and Sweden (DSLR: 47.5% to 70%). Clinical outcomes (distribution of modified Ranking Score (mRS)) with DLSR compared to other MT devices were obtained from the ARISE II study and HERMES, a large meta-analysis. Case volume and country-specific costs for length of stay (LOS) were obtained from published literature; device adoption rates and technology costs from market research; procedural costs were assumed to only differ between cost for technologies. LOS depending on mRS, was informed by a post hoc analysis of ARISE II. Sensitivity analyses were conducted. Costs were reported in 2018 SEK (Sweden), Euros (France).

RESULTS : Among 4,777 patients annually treated with MT in France, 71 additional patients achieved good functional outcomes (mRS 0-2) in the scenario with increased use of the DLSR. Costs for MT patients in France were €85,904 lower in the scenario with increased use of the DLSR (€20,662,040 vs. €20,747,944). Among 408 patients annually treated in Sweden, 20 additional patients achieved good functional outcomes and costs were SEK504,525 lower in the scenario with increased use of the DLSR (SEK26,973,618 vs. SEK27,478,143).

CONCLUSIONS : The adaptation of the UK budget impact analysis to France and Sweden generated directionally comparable results. Additional potential clinical benefits provided by increased adoption of a DLSR may be accompanied by cost-savings.