OBJECTIVES: Mechanical thrombectomy plus intravenous thrombolysis is the treatment of choice for patients with ischemic stroke due in large vessels of the anterior circulation. The number of patients with mechanical thrombectomy has increased. Our objective was to establish if it is cost-effective for the Colombian Health System.

METHODS: We conducted a systematic review of the literature with meta-analysis, limited to randomized controlled trials comparing the efficacy and safety of second-generation mechanical thrombectomy devices for the treatment of patients with ischemic stroke of the large vessels of the anterior circulation. Only direct medical costs were estimated, utilities were derived from the literature. Annual discount rate was 5%. With clinical data extracted from the meta-analysis, we developed a decision tree and a Markov model, with a time horizon of 5 years and the perspective of the Colombian healthcare system, calculated incremental cost-utility ratios, and performed deterministic and probabilistic sensitivity analysis.

RESULTS: Mechanical thrombectomy plus intravenous thrombolysis is more effective than intravenous thrombolysis alone for functional independence, RR 1.59, (95% CI: 1.41-1.78). No difference in mortality RR 0.86 (95% CI: 0.71-1.04) or symptomatic intracranial hemorrhage RR 1.16 (95% CI: 0.76-1.78). In the base case, mechanical thrombectomy plus intravenous thrombolysis has an incremental cost of COP $9,697,228 (USD $2,591) and an incremental utility of 0.453 QALYs. Incremental cost-utility ratio of COP $21,403,843 (USD $5,718). The probabilistic sensitivity analysis, 64 % of the simulations are below thewillingness to pay threshold of COP $22,949,633 (USD $6,131).

CONCLUSIONS: Mechanical thrombectomy plus intravenous thrombolysis provides more functional independence, but no difference in symptomatic intracranial hemorrhage or mortality, and is a cost-effective alternative compared to intravenous thrombolysis alone, for the treatment of anterior circulation large vessel ischemic stroke in the Colombian context.