Background: Six recent multi-centered prospective randomized control trials (MPRCT)showed mechanical thrombectomy significantly improves outcomes of patients with ischemic stroke due to large vessel occlusion. These results were anticipated to have significant impacts on the healthcare costs associated with ischemic stroke. We performed an analysis to determine the cost and utility of combined intravenous (IV) tissue-type plasminogen activator (tPA) and mechanical thrombectomy compared to IV tPA alone for acute large-vessel ischemic stroke.
Methods: A meta-analysis of the six most recent MPRCTs was conducted and data was extracted to calculate the number needed to treat (NNT) and number needed to harm (NNH) based on the pooled results. The average costs of hospitalization for various complications associated with ischemic stroke were separately analyzed. There were two groups: "A" were independent (mRS 0-2) after treatment; "B" were disabled (mRS >2). The costs for hospitalization and post-hospitalization were estimated and a comparison was done between the two groups and compared with IV tPA alone versus tPA plus intervention.
Results: A total of 1,386 patients were included in this analysis from six recent MPRCTs. Of those 698 received IV tPA alone and 688 were treated with thrombectomy and IV tPA. The thrombectomy arm had 46% (n=316) in group A, while the IV tPA alone arm had 27% (n=188) in group A (p=.001). The NNT was 5.1 for patients receiving thrombectomy (p=.001). That translated to 271 more patients becoming independent. The estimated average in-hospital and post-hospital cost for patients in group A was $20,396 and $55,494 for group B. A cost-savings of $14,613,790 would have been achieved, if all patients underwent thrombectomy along with IV tPA.
Conclusions: The addition of thrombectomy to IV tPA translates to substantial cost benefits. If these figures are extrapolated to all stroke patients, the benefits would substantially lessen the economic burden of the entire healthcare system. Thrombectomy after IV tPA makes sense financially as well as clinically. A strong and urgent consideration for amending Healthcare policy and clinical guidelines should be given.