Cost-effectiveness of mechanical thrombectomy for acute ischemic stroke in Brazil: Results from the RESILIENT trial
Ana Cláudia de Souza, Sheila Cristina Ouriques Martins, Carísi Anne Polanczyk, Denizar Vianna Araújo, Ana Paula Beck da Silva Etges, Bruna Stella Zanotto, Jeruza Lavanholi Neyeloff, Leonardo Augusto Carbonera, Márcia Lorena Fagundes Chaves, João José Freitas de Carvalho, Letícia Costa Rebello, Daniel Giansante Abud, Lucas Scotta Cabral, Fabrício Oliveira Lima, Francisco Mont’Alverne, Pedro SC Magalhães, Henrique Diegoli, Juliana Safanelli, Thales André Silveira Salvetti, Bruno de Sousa Mendes Parente, Michel Eli Frudit, Gisele Sampaio Silva, Octávio Marques Pontes‐Neto, Raul G. Nogueira
Abstract
BACKGROUND: The RESILIENT trial demonstrated the clinical benefit of mechanical thrombectomy in patients presenting acute ischemic stroke secondary to anterior circulation large vessel occlusion in Brazil. AIMS: This economic evaluation aims to assess the cost-utility of mechanical thrombectomy in the RESILIENT trial from a public healthcare perspective. METHODS: A cost-utility analysis was applied to compare mechanical thrombectomy plus standard medical care (n = 78) vs. standard medical care alone (n = 73), from a subset sample of the RESILIENT trial (151 of 221 patients). Real-world direct costs were considered, and utilities were imputed according to the Utility-Weighted modified Rankin Score. A Markov model was structured, and probabilistic and deterministic sensitivity analyses were performed to evaluate the robustness of results. RESULTS: The incremental costs and quality-adjusted life years gained with mechanical thrombectomy plus standard medical care were estimated at Int$ 7440 and 1.04, respectively, compared to standard medical care alone, yielding an incremental cost-effectiveness ratio of Int$ 7153 per quality-adjusted life year. The deterministic sensitivity analysis demonstrated that mRS-6 costs of the first year most affected the incremental cost-effectiveness ratio. After 1000 simulations, most of results were below the cost-effective threshold. CONCLUSIONS: The intervention's clear long-term benefits offset the initially higher costs of mechanical thrombectomy in the Brazilian public healthcare system. Such therapy is likely to be cost-effective and these results were crucial to incorporate mechanical thrombectomy in the Brazilian public stroke centers.