OBJECTIVES : Mechanical thrombectomy (MT) is recommended for endovascular treatment of large vessel strokes; however, economic differences amongst MT devices have not been evaluated. This study estimated the budget impact associated with increased adoption of a dual-layer stent retriever (DLSR), EMBOTRAP^®, for large vessel strokes from a U.S. payer perspective.

METHODS : The analysis compared economic outcomes in 150 patients treated in a “current scenario” (device mix: 9% DLSR and 91% other MT devices) to a “future scenario” with increased adoption of the DLSR (30% DLSR and 70% other MT devices) over a 90-day time-horizon. Procedural costs were limited to device costs, as other costs were assumed to be similar. Acute healthcare costs based on 90-day functional outcomes using the modified Rankin Scale (mRS) were analyzed. The proportions of patients achieving each mRS level with the DLSR and other MT devices were obtained from published literature (ARISE II [n=217] for DLSR and SWIFT PRIME [n=98] and TREVO 2000 [n=711] for other MT devices). Acute 90-day healthcare costs per mRS level were based on a 2018 U.S. cost-effectiveness publication. Case volume, device mix, and device costs were obtained from market research. Deterministic sensitivity analyses were conducted. Costs were reported as 2018 U.S. dollars.

RESULTS : Among 150 patients, 91 and 93 patients achieved good functional outcomes (mRS 0-2) in the “current” and “future” scenarios, respectively. Both device and acute healthcare costs were lower in the “future scenario”; total costs were $3,593,125 in the “current” and $3,553,632 in the “future” scenarios, translating to savings of $39,493 over 90-days ($263 per patient). Given the absence of head-to-head trials to inform functional outcomes, a naive comparison was used and is a key limitation of the study.

CONCLUSIONS : In addition to potential clinical benefits, increased adoption of the DLSR for large vessel strokes may lead to cost-savings for the U.S. payer.