Abstract T P309: Cost Effectiveness for Intra-arterial Stroke Therapy Achieved with Image-based Selection and not with Type of Device

Background: Our aim was to determine if stentriever treatment results in cost effectiveness over Merci thrombectomy and to identify a cost-effective imaging threshold for intra-arterial treatment selection. Methods: With institutional approval, we retrospectively reviewed patients undergoing intra-arterial stroke therapy from March 2011 to March 2013 at our center. We collected the following data: stroke score, occlusion site, baseline Alberta Stroke Program Early CT Score (ASPECTS), device used, reperfusion, hemorrhage, 90-day modified Rankin Score (mRS), and procedure cost. Using published criteria, a quality-adjusted life year (QUALY) value of 0.74 and 0.4 was ascribed to a mRS outcome 2 respectively. Using the procedural mean cost, we calculated an incremental cost efficiency ratio (ICER) for stentriever versus Merci embolectomy and for interventions done for a baseline ASPECTS above and below the following thresholds: > 6, > 7, > 8, and > 9. Using established criteria, we identified a cost effective patient selection if the ICER was positive and less than $50,000/QUALY. Results: Our cohort included 122 patients, 45 treated with Merci in the first year and 78 with stentrievers in year two. Reperfusion occurred in 79% (87% in the stentriever and 64% with Merci groups, p=0.002). The good outcome rate for the entire cohort was 40% (43% good outcomes in the stentriever and 33% in the Merci groups, p=0.21) respectively. Stentriever interventions were not cost effective compared to Merci embolectomy (ICER > $500,000/QUALY). Using baseline ASPECTS > 6 and > 7 as a selection criteria for intervention, the good outcome rate was 42% and 44% respectively but with a negative ICER due to higher costs in treating those with lower scores. For those with an ASPECTS > 8 and > 9, the good outcome rate was 44% and 54% with an ICER of $40,000/QUALY and $24,000/QUALY respectively. Conclusions: At our institution, despite better outcome and reperfusion rates, stentriever interventions are yet to show a cost benefit. Optimizing patient selection by using the ASPECTS scoring system has led to improved clinical outcomes and cost effectiveness. Further prospective study may validate this technique for greater value to the individual patient and the health system at large.