OBJECTIVES : Stroke is responsible for mortality and long-term disability in Argentina and it is a highly prevalent condition among the elderly. Available treatments for stroke due to Large Vessel Occlusion (LVO) are Thrombolysis (IV-tPA) and Mechanical Thrombectomy (MT), although the last with low penetration rates despite its international economic value profile. A Cost-Utility Analysis (CUA) was conducted to estimate the economic value of incorporating MT into the existing spectrum of treatments.

METHODS : The CUA was carried-out for a lifetime horizon and from PAMI’s perspective for the eligible population at a starting age of 69,4 years old. The model was adapted and validated to the Argentinian (PAMI) setting. It consisted of seven Health States defined by the mRS scale (including death), organized in a Short-term Decision tree for the acute post-phase -from the onset of symptoms until 90 days-; and Markov from 91 days within the first year, and further annual cycles. Clinical data were obtained from SWIFT PRIME. For each health state, a local cost (Argentinian pesos), a utility (QALY), and probabilities of transition/distribution were identified and discounted (5% rate). Both deterministic and probabilistic sensitivity analyses were performed.

RESULTS : MT after IV-tPA is estimated to be a cost-effective and dominant strategy, with a Net Monetary Benefit (NMB) of AR$2,334.077 and an ICER of AR$-645.272/QALY. Incremental costs were AR$-1.115.532, and long-term costs drop (AR$-1.512.359). The variables that most sensitize the NMB were starting age (62%), long-term costs (43%), and RR of death (29%). NMB was positive in all cases. Including rehabilitation results in a NMB of AR$2,005,002 and an ICER of AR$-490,986. Probabilistic analysis in Montecarlo simulation confirmed these results (1,000 iterations).

CONCLUSIONS : The addition of MT after IV-tPA for treating ischemic stroke due to LVO proved to be cost-effective and dominant in PAMI for the elderly population.