Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator (SST+ tPA) compared with tPA. Previous studies suggested that this strategy may be cost-effective, but models were derived from pooled data and older assumptions.

In this prospective economic substudy conducted alongside the SWIFT-PRIME trial (Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke), in-trial costs were measured for patients using detailed medical resource utilization and hospital billing data. Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension questionnaire. Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors.

Index hospitalization costs were 17183perpatienthigherforSST+tPAthanfortPA( 45 761 versus 28578;P<0.001),drivenbyinitialprocedurecosts.Betweendischargeand90days,costswere 4904 per patient lower for SST+ tPA than for tPA (11270versus 16 174; P= 0.014); total 90-day costs remained higher with SST+ tPA (57031versus 44 752; P< 0.001). Higher utility values for SST+ tPA led to higher in-trial quality-adjusted life years (0.131 versus 0.105; P= 0.005). In lifetime projections, SST+ tPA was associated with substantial gains in quality-adjusted life years (6.79 versus 5.05), cost savings of 23203perpatientandwaseconomicallydominantwhencomparedwithtPAin90%ofbootstrapreplicates.

AmongpatientswithacuteischemicstrokeenrolledintheSWIFT-PRIMEtrial,SSTincreasedinitialtreatmentcosts,butwasprojectedtoimprovequality-adjustedlife-expectancyandreducehealthcarecostsoveralifetimehorizoncomparedwithtPA.

URL:http://www.clinicaltrials.gov.Uniqueidentifier:NCT01657461.