OBJECTIVES:

The beneficial effects of endovascular therapy compared with medical-care alone to treat acute stroke with a large ischemic region have been shown in randomized controlled trial. The aim of this study was to compare the cost-effectiveness of endovascular therapy compared with the established medical-care for the treatment of acute stroke with a large ischemic region in China.

METHODS:

A combination of decision tree and Markov model was developed to assess the cost-effectiveness of endovascular therapy plus medical-care therapy versus medical-care alone over a 20-year time horizon from Chinese healthcare system’s perspective. Efficacy and safety data were derived from the RESCUE-JAPAN LIMIT study. Local costs and utilities were derived from publications and open-access databases. Both one-way and probabilistic sensitivity analysis were carried out to assess the uncertainty of the model results.

RESULTS: The base case analysis showed the cost and effectiveness of treatment with endovascular therapy plus medical-care therapy to be CNY140109.31 and 1.77 quality-adjusted life-years (QALYs), respectively, and the cost and effectiveness of treatment with medical-care therapy alone to be CNY74340.36 and 1.35 QALYs, respectively. The endovascular therapy plus medical-care strategy was associated with an ICER of CNY156532.54 per QALY gained. The main factors influencing the ICER were odds ratio of mRS0-1, discount rate and utility of mRS2-3. The PSA results indicated that at a willingness-to-pay threshold of 3 times the GDP in China, the probability of The endovascular therapy plus medical-care strategy being cost effectiveness was 75%.

CONCLUSIONS:

The addition of endovascular therapy to medical-care therapy is costly and might be cost-effective for acute stroke with a large ischemic region in China.