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Cost-Effectiveness of Endovascular Treatment in Large Vessel Occlusion Stroke With Mild Prestroke Disability: Results From the HERMES Collaboration

Lookup NU author(s): Professor Phil White


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© 2023 Lippincott Williams and Wilkins. All rights reserved. Background: The clinical and economic benefit of endovascular treatment (EVT) in addition to best medical management in patients with stroke with mild preexisting symptoms/disability is not well studied. We aimed to investigate cost-effectiveness of EVT in patients with large vessel occlusion and mild prestroke symptoms/disability, defined as a modified Rankin Scale score of 1 or 2. Methods: Data are from the HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials), which pooled patient-level data from 7 large, randomized EVT trials. We used a decision model consisting of a short-run model to analyze costs and functional outcomes within 90 days after the index stroke and a long-run Markov state transition model (cycle length of 12 months) to estimate expected lifetime costs and outcomes from a health care and a societal perspective. Incremental cost-effectiveness ratio and net monetary benefits were calculated, and a probabilistic sensitivity analysis was performed. Results: EVT in addition to best medical management resulted in lifetime cost savings of $2821 (health care perspective) or $5378 (societal perspective) and an increment of 1.27 quality-adjusted life years compared with best medical management alone, indicating dominance of additional EVT as a treatment strategy. The net monetary benefits were higher for EVT in addition to best medical management compared with best medical management alone both at the higher (100 000$/quality-adjusted life years) and lower (50 000$/quality-adjusted life years) willingness to pay thresholds. Probabilistic sensitivity analysis showed decreased costs and an increase in quality-adjusted life years for additional EVT compared with best medical management only. Conclusions: From a health-economic standpoint, EVT in addition to best medical management should be the preferred strategy in patients with acute ischemic stroke with large vessel occlusion and mild prestroke symptoms/disability.

Publication metadata

Author(s): Ospel JM, Kunz WG, Mcdonough RV, Van Zwam W, Pinckaers F, Saver JL, Hill MD, Demchuk AM, Jovin TG, Mitchell P, Campbell BCV, White P, Muir K, Achit H, Bracard S, Brown S, Goyal M

Publication type: Article

Publication status: Published

Journal: Stroke

Year: 2023

Volume: 54

Issue: 1

Pages: 226-233

Print publication date: 01/01/2023

Online publication date: 06/12/2022

Acceptance date: 28/10/2022

ISSN (print): 0039-2499

ISSN (electronic): 1524-4628

Publisher: Wolters Kluwer Health


DOI: 10.1161/STROKEAHA.121.038407

PubMed id: 36472199


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