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Background and Purpose: Endovascular mechanical thrombectomy is an effective but expensive therapy for acute ischemic stroke with proximal anterior circulation occlusion. This study aimed to determine the cost-effectiveness of mechanical thrombectomy in China, the largest developing country.Methods: A combination of decision tree and Markov model was developed to determine the cost-effectiveness of mechanical thrombectomy within 6 hours with IV tPA treatment within 4.5 hours versus IV tPA treatment alone. Outcomes and costs data were derived from the published literature and claims database. Efficacy data were derived from the patient-level pooled analyses of the 5 trials in 2015. Benefit was assessed by calculating the cost per quality-adjusted life-year (QALY) gained in the long term (30 years). One-way and probabilistic sensitivity analyses were performed to assess the uncertainty of the results.Results: The addition of mechanical thrombectomy compared with standard treatment alone yielded a lifetime gain of 0.934 QALYs at an additional cost of CNY 61,760 (US$ 9,500), resulting in a cost of CNY 66,100 (US$ 10,170) per QALY gained. Probabilistic sensitivity analysis showed that mechanical thrombectomy is cost-effective in 91.9% of the simulation runs at a willingness-to-pay threshold of CNY 125,700 (US$ 19,300) per QALY.Conclusions: Mechanical thrombectomy for acute ischemic stroke caused by proximal anterior circulation occlusion within 6 hours was cost-effective in China. This may be a reference to medical resources allocation for stroke treatment in low- and middle-income countries and the remote areas in the developing countries.