OBJECTIVES:

To compare cost-effectiveness of mechanical thrombectomy (MT) using a stent retriever added to best standard care treatment (BSC) compared to BSC alone in patients with AIS in Poland.

METHODS:

Analysis was performed from public payer (public payer + patient) perspective over a lifetime horizon. A Markov state transition model defined by modified Rankin Scale was used. In base case the model is split into two distinct phases: an acute phase (0–90 days) and a rest-of-life phase (>90 days). Data on effectiveness and safety were taken from a meta-analysis of 5 RCT studies. Utilities and resource utilization were estimated from Polish data sources and clinical expert opinion. Other parameters were in accordance with identified economic analyses. Results were presented for 2 patient’s subgroups: contraindicated to intravenous tissue plasminogen activator (IV rt-PA) and suitable for IV rt-PA. Health outcomes and future costs were discounted respectively at 3.5% and 5.0% following national HTA guidelines. Reliability of estimates was tested in probabilistic (PSA) and one-way (OWSA) sensitivity analyses.

RESULTS:

Estimated total QALYs were 5.29 for MT + BSC and 3.64 for BSC regardless of patient’s subgroup. In patients contraindicated to IV rt-PA average costs per patient were 67,573 PLN (68,220 PLN) for MT + BSC and 16,889 PLN (17,440 PLN) for BSC alone. In patients available for IV rt-PA average costs per patient were 70,879 PLN (71,525 PLN) for MT + BSC and 23,737 PLN (24,287 PLN) for BSC alone. Estimated differences for QALYs and costs were statistically significant. Incremental cost-utility ratio (ICUR) ranged from 28,566 PLN to 30,771 PLN for acceptability threshold of 125,955 PLN. MT + BSC was also cost-effective in PSA and OWSA. Base case results were confirmed by sensitivity analysis.

CONCLUSIONS:

Mechanical thrombectomy, using a stent retriever, added to BSC is cost-effective compared with BSC alone.