Mechanical Thrombectomy versus Best Medical Management for Acute Ischemic Stroke in Elderly Patients: A Cost-Effectiveness Analysis.

OBJECTIVE: To determine the cost-effectiveness of mechanical thrombectomy (MT) versus best medical management (BMM) in patients ≥80 years.

METHODS: We performed a systematic literature review to identify comparative studies of MT vs BMM with or without intravenous tissue-type plasminogen activator (IV tPA) in patients ≥80 years. Clinical data including outcomes and mortality categorized as modified Rankin scale (mRS) scores 0-2, 3-5, and 6 were collected from identified studies, and effectiveness scores were assigned to each outcome. Costs associated with stroke outcomes were derived from previous literature, including costs associated with initial and follow-up imaging, hospitalization, physicians/associated personnel, and MT. TreeAge Pro software (Williamstown, MA) was used to construct a cost-effectiveness analysis model of clinical data from studies and costs derived from the literature.

RESULTS: The review identified 1 relevant comparative study. The cost model demonstrated total annual cumulative overall per-patient costs of $30,064.21 for BMM with IV tPA and $21,940.36 for BMM without IV tPA. Overall effectiveness scores were 0.61 and 0.62, respectively. MT had a cumulative total annual per-patient cost of $47,849.54 and an overall effectiveness score of 0.40. The cost-effectiveness ratios of total cumulative patient cost-to-overall outcome effectiveness score for the three treatments were: BMM with IV tPA=$49,285.59, BMM without IV tPA=$35,387.58, and MT=$119,623.85. BMM with or without IV tPA was found to be more cost-effective than MT.

CONCLUSIONS: This study utilized stroke outcomes data for patients ≥80 years to conduct a cost-effectiveness analysis. MT was found to be less cost-effective than BMM with and without IV tPA.