Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial. Issue 8 (October 2022)

• Record Type: Journal Article
• Authors: de Souza, Ana Claudia; Martins, Sheila O; Polanczyk, Carisi Anne; Araújo, Denizar Vianna; Etges, Ana Paula BS; Zanotto, Bruna Stella; Neyeloff, Jeruza Lavanholi; Carbonera, Leonardo Augusto; Chaves, Márcia Lorena Fagundes; de Carvalho, João José Freitas; Rebello, Letícia Costa; Abud, Daniel Giansante; Cabral, Lucas Scotta; Lima, Fabrício O; Mont'Alverne, Francisco; SC Magalhães, Pedro; Diegoli, Henrique; Safanelli, Juliana; André Silveira Salvetti, Thales; de Sousa Mendes Parente, Bruno; Eli Frudit, Michel; Silva, Gisele Sampaio; Pontes-Neto, Octávio M; Nogueira, Raul G
• Is Part Of: International journal of stroke. Volume 17:Issue 8(2022)
• Page Start: 855
• Page End: 862
• Publication Date: 2022-10
• Subjects: Stroke -- mechanical thrombectomy -- cost-effectiveness -- economic evaluation; 616.8005
• DOI: 10.1177/17474930211055932
• Languages: English
• ISSNs: 1747-4930

Abstract

Background: The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil. Aims: This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective. Methods: A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results. Results: The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold. Conclusions: The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.