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The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study

Lookup NU author(s): Dr Diarmuid Coughlan, Professor Phil White, Dr Peter McMeekin, Dr Darren Flynn, Professor Dawn Craig, Hannah Lumley, Stephen Rice

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Abstract

INTRODUCTION: The clinical efficacy and cost-effectiveness of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke is well established, but uncertainty remains around the true cost of delivering this treatment within the NHS. The aim of this study was to establish the cost of providing MT within the hyperacute phase of care and to explore differences in resources used and costs across different neuroscience centres in the UK.METHOD: This was a multicentre retrospective study using micro-costing methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018.RESULTS: Data were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527-11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649-8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381-1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345-2,719; p<0001).The mean cost within 72 hours was £12,440 (95% CI 10,628-14,252). The total costs for the duration of inpatient care before discharge from a thrombectomy centre was £14,362 (95% CI 13,603-15,122).CONCLUSIONS: Major factors contributing to costs of MT for stroke include consumables and staff for intervention, use of general anaesthesia and ICU admissions. These findings can inform the reimbursement, provision and strategic planning of stroke services and aid future economic evaluations.


Publication metadata

Author(s): Balami JS, Coughlan D, White PM, McMeekin P, Flynn D, Roffe C, Natarajan I, Chembala J, Nayak S, Wiggam I, Flynn P, Simister R, Sammaraiee Y, Sims D, Nader K, Dixit A, Craig D, Lumley H, Rice S, Burgess D, Foddy L, Hopkins E, Hudson B, Jones R, James MA, Buchan AM, Ford GA, Gray AM

Publication type: Article

Publication status: Published

Journal: Clinical Medicine Journal

Year: 2020

Volume: 20

Issue: 3

Pages: e40-e45

Online publication date: 15/05/2020

Acceptance date: 02/04/2016

Date deposited: 19/05/2020

ISSN (print): 1470-2118

ISSN (electronic): 1473-4893

Publisher: Royal College of Physicians

URL: https://doi.org/10.7861/clinmed.2019-0413

DOI: 10.7861/clinmed.2019-0413

PubMed id: 32414740


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