The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory.
Publication/Presentation Date
1-17-2025
Abstract
BACKGROUND: Mechanical thrombectomy (MT) for acute ischemic stroke is generally avoided when the expected infarction is large (defined as an Alberta Stroke Program Early CT Score of < 6).
OBJECTIVE: To perform a meta-analysis of recent trials comparing MT with best medical management (BMM) for treatment of acute ischemic stroke with large infarction territory, and then to determine the cost-effectiveness associated with those treatments.
METHODS: A meta-analysis of the RESCUE-Japan, SELECT2, and ANGEL-ASPECT trials was conducted using R Studio. Statistical analysis employed the weighted average normal method for calculating mean differences from medians in continuous variables and the risk ratio for categorical variables. TreeAge software was used to construct a cost-effectiveness analysis model comparing MT with BMM in the treatment of ischemic stroke with large infarction territory.
RESULTS: The meta-analysis showed significantly better functional outcomes, with higher rates of patients achieving a modified Rankin Scale score of 0-3 at 90 days with MT as compared with BMM. In the base-case analysis using a lifetime horizon, MT led to a greater gain in quality-adjusted life-years (QALYs) of 3.46 at a lower cost of US$339 202 in comparison with BMM, which led to the gain of 2.41 QALYs at a cost of US$361 896. The incremental cost-effectiveness ratio was US$-21 660, indicating that MT was the dominant treatment at a willingness-to-pay of US$70 000.
CONCLUSIONS: This study shows that, besides having a better functional outcome at 90-days' follow-up, MT was more cost-effective than BMM, when accounting for healthcare cost associated with treatment outcome.
Volume
17
Issue
2
First Page
223
Last Page
228
ISSN
1759-8486
Published In/Presented At
Aslan, A., Abuzahra, S., Adeeb, N., Musmar, B., Salim, H. A., Kandregula, S., Dmytriw, A. A., Griessenauer, C. J., De Alba, L., Arevalo, O., Burkhardt, J. K., Pereira, V. M., Jabbour, P., Guthikonda, B., & Cuellar, H. H. (2025). The feasibility of mechanical thrombectomy versus medical management for acute stroke with a large ischemic territory. Journal of neurointerventional surgery, 17(2), 223–228. https://doi.org/10.1136/jnis-2023-021368
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
38471764
Department(s)
Administration and Leadership
Document Type
Article