Intraarterial Thrombectomy for Acute Ischemic Stroke: Cost-Effective or Dominant across All Age Groups in Brazil
Author(s)
Magalhães P1, Makdisse M1, Moro CHC2, Longo AL3, França PHC4, Diegoli H5
1Academia VBHC, Sao Paulo, SP, Brazil, 2São José Hospital, Joinville, Brazil, 3Joinville Stroke Registry, Joinville, Brazil, 4University of Joinville's Region, Joinville, Santa Catarina, Brazil, 5Academia VBHC, Joinville, SC, Brazil
OBJECTIVES: To assess the cost-utility of intraarterial thrombectomy (IAT) vs. intravenous thrombolysis (IVT) in acute ischemic stroke associated with large vessel occlusion from the Brazilian Public Healthcare System Perspective.
METHODS: A Markov model simulated lifetime costs and benefits with IVT or IAT for various stroke onset ages (20-90 years). Data from 8,231 Joinville Stroke Registry (Joinvasc) patients informed follow-up transition probabilities, resource utilization, and post-stroke quality of life. Time-driven activity-based costing in 830 patients with informed hospital costs, medical visits, and rehabilitation. Drug costs originated from the Drug Market Regulation Chamber. Propensity-score matching of 150 IAT and 141 IVT Joinvasc patients informed 3-month outcomes, stratified as independent (modified Rankin Scale [MRS] 0-2), dependent (MRS 3-5), or dead, and were age-stratified (<70 and ≥70 years). A 5% alpha level was considered statistically significant. Results were discounted 5% annually and reported in 2023 Brazilian Reais (purchasing power parity: U$ 1.00 = R$ 2.66), with a cost-effectiveness threshold of R$ 120,000 per quality-adjusted life-year (QALY).
RESULTS: In patients <70 years, IAT vs. IVT increased 3-months independence (54.7% vs. 33.4%; P=0.008) and reduced case-fatality (11.6% vs. 26.8%; P=0.016), and ≥70 years IAT also improved independence (36.4% vs. 14.8%; P= 0.004), but not case-fatality (34.5% vs. 32.8%; P=0.834). On weighted average of age groups, IAT vs. IVT increased years of life gained (6.1 vs. 4.9) and QALYs (3.9 vs. 2.8), direct costs (R$ 45,580 vs. R$ 32,164), and reduced indirect costs (R$ 66,852 vs. R$ 74,268), increasing total costs (R$ 112,432 vs. R$ 106,432). Therefore, IAT was cost-effective (R$ 5,447/QALY). In patients younger than 48, IAT lowered total costs (dominant choice), while in older patients it was cost-effective (maximum R$ 45,559/QALY in 90-year-old patients).
CONCLUSIONS: IAT stands out as either dominant or cost-effective for stroke patients across all age groups in Brazil.
Conference/Value in Health Info
Value in Health, Volume 26, Issue 11, S2 (December 2023)
Code
EE460
Topic
Clinical Outcomes, Economic Evaluation, Medical Technologies, Study Approaches
Topic Subcategory
Clinical Outcomes Assessment, Cost-comparison, Effectiveness, Utility, Benefit Analysis, Medical Devices, Registries
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), No Additional Disease & Conditions/Specialized Treatment Areas
Explore Related HEOR by Topic