OBJECTIVES: To evaluate the cost-effectiveness of intraarterial thrombectomy (IAT) plus intravenous thrombolysis (IVT) versus IVT alone for treatment of patients with severe ischemic stroke in Brazil.

METHODS: Using the Brazilian Unified Health System’s perspective, we developed a decision tree for the acute phase (0–90 days) and used a Markov model until 30 years after a stroke. Health status was assessed based on the modified Rankin scale (MRS). We derived long-term transition probabilities from real-world population-based data (n=1,324). IAT-treated patients were matched with IVT-treated patients using propensity scores (n=191) for clinical effectiveness input. Resource use and costs for the acute phase were obtained from patients admitted to a public hospital with severe IS (n=118), and long-term readmission costs and costs with outpatient visits and rehabilitation were obtained from patients from the same hospital followed after stroke (n=403).

RESULTS: IAT treatment led to better outcomes at 90 days (P=0.031), increasing functional independence by 20% (52% versus 32%) and reducing mortality by 10% (24% versus 34%). In lifetime results modelling, IAT was associated with 1.17 quality-adjusted life-years (QALY) gained. Incremental cost per one QALY gained (incremental cost-effectiveness ratio) was USD 4,343.79. In sensitivity analysis, IAT shown to be cost-effective in 99.4% of simulations.

CONCLUSIONS: IAT can be considered a cost-effective technology for patients with severe IS in the public setting in Brazil. Future research could extend to more centers in Brazil and other developing countries.