OBJECTIVES: Endovascular thrombectomy (EVT) is one of the most prominent treatments for ischemic stroke. Although its efficacy has been shown in many randomized controlled studies (RCTs) and EVT and spreading EVT administrations is an urgent political challenge, its cost-effectiveness has not been analyzed in Japan. The objective of this study is to analyze its cost-effectiveness in the Japanese setting.

METHODS: The subjects were ischemic stroke patients treated in Japan who were eligible for endovascular thrombectomy. A cost-utility analysis was conducted from the public healthcare payer’s perspective compared to the conventional treatments. The time horizon was ten years. A decision-tree model and a Markov model were used for the first 90 days and after that period, respectively. The Markov model comprises the health states of modified Rankin Scale (mRS) 0-2 (physically independent), mRS3-5 (severe), and mRS6 (death).

RESULTS: Results: In the base case, EVT incurred additional 0.31 quality-adjusted life years (QALY) and $US3,078 compared to the conventional treatments, and the incremental cost-effectiveness ratio (ICER) was $US9,820 per QALY, lower than the reference value used in the Japanese cost-effectiveness evaluation (JPY 5 million/QALY, which approximately equals to $US31,631). The results of deterministic sensitivity analysis and probabilistic sensitivity analysis also showed that the ICERs were likely under the reference value.

CONCLUSIONS: Those results indicated that EVT would likely be cost-effective in the Japanese setting.