OBJECTIVES: Balloon guide catheters (BGCs) can be used adjunctively during mechanical thrombectomy (MT) procedures to arrest blood flow and improve reperfusion in the treatment of Acute Ischemic Stroke (AIS). Two recent meta-analyses reported significantly higher rates of 90-day good functional outcomes (modified Rankin Score (mRS) 0-2), in procedures utilizing MT+BGC vs. MT alone. This analysis aims to evaluate the potential economic impact of achieving improved functional outcomes associated with adjunctive BGC use.

METHODS: A cost analysis evaluated 1,000 simulated patients, assuming 90-day survival post AIS (mRS 0-5) from a U.S payer perspective. Functional benefit was defined as improved mRS shift, i.e. higher proportion of patients in mRS 0-2 category hence lower proportion in mRS 3-5, with MT+BGC vs. MT alone. Weighted average costs of mRS 0-2 and 3-5 (regardless of BGC use) were calculated based on the proportion of patients achieving each mRS (HERMES) and 1-year mRS costs (SWIFT-PRIME). Per-patient costs were compared between MT+BGC vs. MT alone. A deterministic scenario analysis was used to vary the functional benefit based on the 95% confidence intervals reported for MT+BGC mRS 0-2.

RESULTS: MT+BGC compared to MT alone had higher rates of mRS 0-2 (62.7% vs. 53.7%) and lower rates of mRS 3-5 (37.3% vs. 46.3%). The weighted average costs associated with achieving mRS 0-2 and 3-5 are estimated at $13,518 and $43,856, respectively. Estimated 1-year cost-savings associated with improved mRS shift in the MT+BGC group was $2,740 per-patient. Varying this functional benefit resulted in cost-savings ranging from $1,403 to $4,008.

CONCLUSIONS: Adjunctive use of BGC with MT for AIS is associated with significantly improved 90-day good functional outcomes which may lead to 1 year per-patient cost-savings of $2,740. Further studies are needed to ascertain if newer generation MT and BGC devices may result in even better outcomes and additional cost savings.