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Cost-effectiveness of endovascular thrombectomy for acute ischemic stroke with established large infarct in Germany: a decision tree and Markov model

S. Gottschalk, HH. König, F. Subtil, S. Bonekamp, A. Denis, AH. Aamodt, B. Fuentes, ER. Gizewski, MD. Hill, A. Krajina, L. Pierot, CZ. Simonsen, K. Zeleňák, M. Bendszus, G. Thomalla, J. Dams

. 2025 ; 17 (7) : 683-690. [pub] 20250616

Language English Country England, Great Britain

Document type Journal Article

Persistent link   https://www.medvik.cz/link/bmc25015301

BACKGROUND: Recent studies, including the TENSION trial, support the use of endovascular thrombectomy (EVT) in acute ischemic stroke with large infarct (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 3-5). OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective. METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties. RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups. CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.

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$a Cost-effectiveness of endovascular thrombectomy for acute ischemic stroke with established large infarct in Germany: a decision tree and Markov model / $c S. Gottschalk, HH. König, F. Subtil, S. Bonekamp, A. Denis, AH. Aamodt, B. Fuentes, ER. Gizewski, MD. Hill, A. Krajina, L. Pierot, CZ. Simonsen, K. Zeleňák, M. Bendszus, G. Thomalla, J. Dams
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$a BACKGROUND: Recent studies, including the TENSION trial, support the use of endovascular thrombectomy (EVT) in acute ischemic stroke with large infarct (Alberta Stroke Program Early Computed Tomography Score (ASPECTS) 3-5). OBJECTIVE: To evaluate the cost-effectiveness of EVT compared with best medical care (BMC) alone in this population from a German healthcare payer perspective. METHODS: A short-term decision tree and a long-term Markov model (lifetime horizon) were used to compare healthcare costs and quality-adjusted life years (QALYs) between EVT and BMC. The effectiveness of EVT was reflected by the 90-day modified Rankin Scale (mRS) outcome from the TENSION trial. QALYs were based on published mRS-specific health utilities (EQ-5D-3L indices). Long-term healthcare costs were calculated based on insurance data. Costs (reported in 2022 euros) and QALYs were discounted by 3% annually. Cost-effectiveness was assessed using incremental cost-effectiveness ratios (ICERs). Deterministic and probabilistic sensitivity analyses were performed to account for parameter uncertainties. RESULTS: Compared with BMC, EVT yielded higher lifetime incremental costs (€24 257) and effects (1.41 QALYs), resulting in an ICER of €17 158/QALY. The results were robust to parameter variation in sensitivity analyses (eg, 95% probability of cost-effectiveness was achieved at a willingness to pay of >€22 000/QALY). Subgroup analyses indicated that EVT was cost-effective for all ASPECTS subgroups. CONCLUSIONS: EVT for acute ischemic stroke with established large infarct is likely to be cost-effective compared with BMC, assuming that an additional investment of €17 158/QALY is deemed acceptable by the healthcare payer.
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$a König, Hans-Helmut $u Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany $u Hamburg Center for Health Economics, Hamburg, Germany
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$a Subtil, Fabien $u Service de Biostatistique, Hospices Civils de Lyon, Lyon, France $u Laboratoire de Biométrie et Biologie Évolutive, Université Lyon 1, Villeurbanne, France
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$a Bonekamp, Susanne $u Department of Neuroradiology, Heidelberg University Hospital, Heidelberg, Germany
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$a Denis, Angelique $u Service de Biostatistique, Hospices Civils de Lyon, Lyon, France $u Laboratoire de Biométrie et Biologie Évolutive, Université Lyon 1, Villeurbanne, France
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$a Aamodt, Anne Hege $u Department of Neurology, Oslo University Hospital, Oslo, Norway $u The Norwegian University of Science and Technology, Trondheim, Norway
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$a Gizewski, Elke R $u Department of Neuroradiology, Medical University of Innsbruck, Innsbruck, Tirol, Austria
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$a Krajina, Antonin $u Department of Radiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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$a Pierot, Laurent $u Department of Neuroradiology, Hôpital Maison-Blanche, Université de Reims Champagne-Ardenne, Reims, France $1 https://orcid.org/0000000225234909
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$a Simonsen, Claus Ziegler $u Department of Neurology, Aarhus University Hospital, Aarhus, Denmark $1 https://orcid.org/0000000313630266
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$a Thomalla, Götz $u Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany
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