Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: A United States and European perspective

Osama O. Zaidat, Marc Ribo, Heinrich Paul Mattle, Jeffrey L. Saver, Hormozd Bozorgchami, Albert J. Yoo, Alexandra Ehm, Emilie Kottenmeier, Heather L. Cameron, Rana A. Qadeer, Tommy Andersson

Research output: Contribution to journalReview articlepeer-review

Abstract

Background: First-pass effect (FPE), restoring complete or near complete reperfusion (modified Thrombolysis in Cerebral Infarction (mTICI) 2c-3) in a single pass, is an independent predictor for good functional outcomes in the endovascular treatment of acute ischemic stroke. The economic implications of achieving FPE have not been assessed. Objective: To assess the economic impact of achieving complete or near complete reperfusion after the first pass. Methods: Post hoc analyses were conducted using ARISE II study data. The target population consisted of patients in whom mTICI 2c-3 was achieved, stratified into two groups: (1) mTICI 2c-3 achieved after the first pass (FPE group) or (2) after multiple passes (non-FPE group). Baseline characteristics, clinical outcomes, and healthcare resource use were compared between groups. Costs from peer-reviewed literature were applied to assess cost consequences from the perspectives of the United States (USA), France, Germany, Italy, Spain, Sweden, and United Kingdom (UK). Results: Among patients who achieved mTICI 2c-3 (n=172), FPE was achieved in 53% (n=91). A higher proportion of patients in the FPE group reached good functional outcomes (90-day modified Rankin Scale score 0-2 80.46% vs 61.04%, p<0.01). The patients in the FPE group had a shorter mean length of stay (6.10 vs 9.48 days, p<0.01) and required only a single stent retriever, whereas 35% of patients in the non-FPE group required at least one additional device. Driven by improvement in clinical outcomes, the FPE group had lower procedural/hospitalization-related (24-33% reduction) and annual care (11-27% reduction) costs across all countries. Conclusions: FPE resulted in improved clinical outcomes, translating into lower healthcare resource use and lower estimated costs.

Original languageEnglish (US)
Article number016930
JournalJournal of neurointerventional surgery
DOIs
StateAccepted/In press - 2020

Keywords

  • economics
  • stroke
  • thrombectomy

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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