The Emergence of Mechanical Thrombectomy as the standard of care.
A remarkable transformation of stroke care has occurred over the last two decades with the development of evidence-based stroke detection, increased access to advance care, and improved emergency management of stroke.
MT is considered a breakthrough in stroke treatment for LVO stroke. The mechanical removal of blood clots from blood vessels supplying the brain leads to better outcomes for stroke patients, including faster
and greater independence and mobility. Numerous clinical trials have established proof of better outcomes with MT in 2015, leading to widespread adoption.
Despite the effectiveness of treatment, only 100,000 to 200,000 patients are estimated to receive this life saving therapy.
Current US & World MT Procedure Estimates
• US Device Industry estimates
• Worldwide Device Industry estimates
2016: 79,000 (22K US, 27K Europe, 30K Asia, Australia)
2017: 106,000 (32K US, 30K Europe, 43K Asia, Australia)
2018: Estimated 156,000
Mechanical Thrombectomy is costly but is cost- effective.
In the United States, Acute Ischemic Stroke is associated with a high economic burden, especially for patients discharged with a stroke-related disability who incur more than double the expense compared to non-disabled patients ($120,753 vs. $54,580). Even though combination therapy has a higher cost for initial hospitalization ($17,183) than standard therapy (clot-disrupting IVT agents), it has a lifetime savings of $23,203 per patient because of the substantial reduction in disability, plus improvements in the overall quality of life. Additionally, it is associated with lower post-stroke rehabilitation and nursing care (90-day cost) and lifetime costs. It’s projected that the total cost of stroke from 2005 to 2050 will be 2.2 trillion dollars includes direct and indirect costs in the United States alone.
The Canadian average annual cost of AIS is $2.8 billion, with an average per-patient cost of $75,353/year. Similar to the data from the US, the average annual cost for patients with a stroke related disability is more than double that of nondisabled patients ($107,883 vs. $48,339).AIS treatment with combination therapy is estimated to save the Canadian healthcare system $321,334/year.
Combination therapy in the UK is similarly associated with higher initial hospitalization costs than standard care ($64,757.28 vs. $52,494.73). Combination therapy is not cost-effective in the short-term (90 days) but is estimated to be cost-effective over 20 years and a lifetime horizon, and if fully implemented, the projected value is estimated to be £1.3 billion ($1.7 billion) over five years.
Mirroring the US results, in France, initial hospitalization costs are $2,116 more for combination therapy than standard care; however, these patients experience a 10.9% increase in functional independence 90 days post stroke. The estimated cost per one Quality Adjusted Life Year (QALY) gained is $14,880 and the estimated net monetary benefit is $2,757, indicating the cost effectiveness of MT at one-year.
In Sweden, MT procedures increase intervention costs (+£9000 [$11,779]) but result in substantial overall cost savings in the long run due to a lower reliance on home medical (home help services – £13,000 [$17,014]) services or nursing home care (£26,000 [$34,027])
From the perspective of the Italian National Healthcare System (NHS), combination therapy for LVO stroke is cost-effective between 1-3 years post-stroke and cost savings from year 4 onwards. At 1 year, MT is more expensive than standard care by €4.078,37 ($4,553.77) (€13,430.81 [$14,996.37] vs. €9,352.44 [$10,442.61]). At year 5, combination therapy is associated with a cost savings of €3,057 ($3,411) when compared to standard care (€31,798 [$35,483] vs. €34,855 [$38,895]).
Matching the US results, from the perspective of the Spanish NHS, when compared to standard care, combination therapy has higher treatment costs (€8,428.00 [US $9,405] vs. €1,606.00 [US $1792]) and lower overall costs (€123,866 [US $138,228] vs. €168,244 [US $187,752]), along with a net monetary benefit of €119,744 (US $133,628).221 Patients treated with combination therapy also have improved health outcomes with 1.17 life years gained. Therefore, combination therapy for LVO AIS patients is less costly and more beneficial than standard care alone.
Combination therapy has higher hospital costs ($10,666/patient) in Australia but results in a lifetime savings of more than $8,000/patient when compared to standard care. For the first 90 days, average inpatient costs are less for patients receiving combination therapy compared to standard care ($15,689 vs. $30,569), counterbalancing the additional costs of inter-hospital transport (average $573) and the MT procedure (average $10,515), resulting in an average savings of $4,365/patient ($29,371 vs. $33,736). Patients treated with MT also have shorter hospital (5 vs. 8 days) and rehabilitation stays (0 vs. 27 days) and gain 4.4 life years than those treated with standard care.
In China, combination therapy is not considered cost-effective at 5 years post stroke, but at 6 years and thereafter, it is considered cost-effective.2
Stroke Mechanical Thrombectomy: Building Thrombectomy Systems Of Care In Your Region; Why And How? -White paper. “Stroke policies are local, best practices are global.”