OBJECTIVES

Following recent evidence showing that mechanical thrombectomy (MT) beyond 6 hours after advanced-imaging improves health outcomes, stroke care is expected to evolve internationally. Geographic transferability of existing economic models may be efficient and relevant to early assess the value of late MT for ischaemic stroke patients in countries where little or even no evidence or data is available. The aim of this study was to transfer a validated cost-effectiveness model assessing the value of late MT from the UK to Hungary, Sweden and Germany and to compare the country-specific results.

METHODS

The original UK-based model was validated and assessed for transferability to Hungary, Sweden and Germany. Input parameters identified as critical transferability-limiting factors were localized according to the best available local data. Country-specific estimates of cost-effectiveness were calculated and results were compared across the four investigated countries.

RESULTS

While the structure of the UK-based model appeared transferable, all cost and utility parameters and all probabilities related to the stroke care pathway and demography needed localization. Our preliminary analyses show that, over a lifetime horizon, country-specific incremental cost-effectiveness ratios (ICERs) in Euros per QALY gained varied broadly: €42,054 for the UK, €62,912 for Sweden, €64,694 for Hungary, and €70,094 for Germany. Results of our PSA showed important variations between countries in terms of probability for the late MT pathway to be cost-effective at fixed willingness-to-pay thresholds.

CONCLUSIONS

Transferability of the original UK-based model appeared to be an efficient method to provide a preliminary assessment and comparison of the cost-effectiveness of late MT following advanced-imaging for ischaemic stroke patients in Hungary, Sweden and Germany. More research is needed to sharpen and ascertain our country-specific results before the most cost-effective stroke care pathway, including diagnostic and treatment, can be recommended per country.