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

Zaidat, Osama O; Ribo, Marc; Mattle, Heinrich Paul; Saver, Jeffrey L; Bozorgchami, Hormozd; Yoo, Albert J; Ehm, Alexandra; Kottenmeier, Emilie; Cameron, Heather L; Qadeer, Rana A; Andersson, Tommy (2020). Health economic impact of first-pass success among patients with acute ischemic stroke treated with mechanical thrombectomy: a United States and European perspective. Journal of neurointerventional surgery BMJ Publishing Group 10.1136/neurintsurg-2020-016930

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Neurology

UniBE Contributor:

Mattle, Heinrich

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1759-8486

Publisher:

BMJ Publishing Group

Language:

English

Submitter:

Chantal Kottler

Date Deposited:

26 Jan 2021 16:52

Last Modified:

17 Mar 2021 04:40

Publisher DOI:

10.1136/neurintsurg-2020-016930

PubMed ID:

33443119

BORIS DOI:

10.48350/150755

URI:

https://boris.unibe.ch/id/eprint/150755

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