Endovascular Thrombectomy with or without Bridging Thrombolysis: A Cost-Utility Analysis

Introduction: There is clinical equipoise behind bridging intravenous thrombolysis (BT) with endovascular thrombectomy (EVT). We performed a cost-effectiveness analysis comparing BT versus EVT alone.

Method(s): We conducted a model-based cost-utility analysis comparing the cost-effectiveness of EVT alone versus BT for patients with acute ischemic stroke. We used a decision tree to examine the short-term costs and outcomes at 90 days after the index stroke. Subsequently, we developed a Markov state transition model to assess the costs and outcomes over 1-, 5-, and 20-year time horizons. We estimated total and incremental cost, quality-adjusted life years, and incremental cost-effectiveness ratio.

Result(s): At a fixed willingness to pay threshold of $50,000, the probabilities of EVT only to be cost-effective were 100, 100, 99.0, and 65.9% over 90-day, 1-year, 5-year, and 20-year time horizons.

Conclusion(s): Our cost-effectiveness model suggested that bridging with thrombolytics may not be cost-effective for patients with acute ischemic stroke secondary to large vessel occlusion.

Publication History

Article published online:
09 February 2023