Background: Ischemic-Stroke (IS) is a prevalent disease in Chile, responsible for long-term disability and premature deaths. Available treatments for IS due to Large Vessel Occlusion (LVO) are Thrombolysis (IV-tPA) and Mechanical Thrombectomy (MT). However, MT is not funded by any local-coverage regimen. A Cost-Utility Analysis (CUA) was conducted to estimate the economic-value of adding MT to the current IV-tPA treatment in Chile.

Methods: A University of York Health Economics Consortium Model was validated and adapted to the Chilean setting. The CUA was carried-out for a lifetime horizon and from two perspectives: public payor and societal. A scoping review was conducted to validate key variables according to CHEERS criteria. Variables of a Mixed Model were validated and adapted: Short-term Decision tree for the acute post-phase -from the onset of symptoms until 90 days-; And Markov from 91 days to the first year, and then annual cycles. The Model consists of seven Health States defined by the mRS scale (including death). Sources of local costs were Related-Diagnosis Groups (DRGs) of a sample of high-complexity public providers and bundled-payment tariffs. For each Health State, a local cost (Chilean pesos), a utility (QALY), and probabilities of transition/distribution were identified. The discount rate was 3%.

Results: Over a lifetime period, MT after IV-tPA is estimated to be cost-effective leading to a gain of +2.63 QALYs and +1.19 life years (LY), with an Net Monetary Benefit (NMB) of $37,289,874 and an ICER of $3,807,413/QALY. After adding Physical Therapy costs, MT after IV-tPA remains cost-effective (+2.54 QALYs, +1,13 LY, NMB is $35,670,319, and ICER is $3,960,624/QALY). With the incorporation of long-term costs in care-dependent groups, ICER drops ($951,911/QALY), and NMB improves ($43,318,072). Sensitivity analyses confirm the robustness of these results (1,000 iterations).

Conclusion: The addition of MT after IV-tPA for treating IS due to LVO showed to be cost-effective in Chile.