OBJECTIVES: Patients with acute ischemic stroke due to large vessel occlusion (LVO), when eligible, are usually transferred from the emergency room to the angiography suite to undergo endovascular thrombectomy (EVT). Recently, the strategy of direct transfer of suspected LVO patients to the angiography suite (DTAS) has been shown to improve functional outcome. The present study aims to evaluate the cost-effectiveness of the DTAS strategy versus transfer of suspected LVO patients to the emergency room (ITER).

METHODS: A decision-analytic and attached Markov model were developed to estimate the cost-effectiveness of the DTAS strategy versus the ITER strategy from a Dutch healthcare perspective with a ten-year time horizon. The primary outcome was the incremental cost-effectiveness ratio (ICER) with the Dutch thresholds (€50,000 and €80,000 per quality-adjusted life year (QALY)). Uncertainty of input parameters was assessed using one-way sensitivity analysis, scenario analysis and probabilistic sensitivity analysis.

RESULTS: The DTAS strategy yielded 0.32 additional QALYs at an additional €7,319, resulting in an ICER of €22,807 per QALY compared to the ITER strategy. The ICER varied from €24,768 to €32,045/QALY in different scenarios. The ICER was particularly sensitive to the utility scores of the more advantageous, i.e., long-term care-independent stroke outcomes and the EVT costs. The probabilistic sensitivity analysis showed that the DTAS strategy had an 89% and 96% likelihood of being cost-effective at a willingness-to-pay threshold of €50,000/QALY and €80,000/QALY, respectively.

CONCLUSIONS: The DTAS strategy had robust cost-effectiveness for patients suspected of LVO. Implementation of the DTAS strategy should be considered to improve the workflow of EVT.