The economic impact associated with stent retriever selection for the treatment of acute ischemic stroke: a cost–effectiveness analysis of MASTRO I data from a Chinese healthcare system perspective
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: The aim of this analysis was to assess the cost–effectiveness of the EmboTrap® Revascularization Device compared with the Solitaire™ Revascularization Device and Trevo® Retriever for the treatment of acute ischemic stroke (AIS) from the perspective of the Chinese healthcare system. Methods: According to MASTRO I, a recent living systematic literature review and meta-analysis, mechanical thrombectomy (MT) with EmboTrap in the treatment of AIS resulted in better functional outcomes compared with the use of Solitaire or Trevo. Based on the proportion of patients that achieved 90-day modified Rankin Scale (mRS) scores of 0–2, 3–5 and 6 reported in MASTRO I, a combined 90-day short-term decision tree and Markov model with a 10-year time horizon was used to compare the cost–effectiveness of the three devices. The primary outcome was the incremental cost–effectiveness ratio (ICER), representing the incremental cost (in 2022 Chinese Yuan [CNY]) per incremental quality-adjusted life-year (QALY). The ICERs were compared against willingness-to-pay (WTP) thresholds of 1, 1.5 and 3-times the 2022 national gross domestic product (GDP) per capita in China. Results: Treatment with EmboTrap resulted in total QALYs of 3.28 and total costs of 110,058 CNY per patient. Treatment with Trevo resulted in total QALYs of 3.05 and total costs of 116,941 CNY per patient. Treatment with Solitaire resulted in total QALYs of 2.81 and total costs of 99,090 CNY per patient. Trevo was dominated by EmboTrap as it was a more costly and less effective intervention. As such, Trevo was not cost-effective at any WTP threshold. Compared with Solitaire, EmboTrap was more effective and more costly, with an ICER of 23,615 CNY per QALY. This result suggests that EmboTrap is cost-effective when compared with Solitaire since the ICER was lower than all WTP thresholds assessed. Conclusion: EmboTrap dominated Trevo and is cost-effective for the treatment of patients with AIS compared with Solitaire when assessed from the perspective of the Chinese healthcare system and based on the device-level meta-analysis MASTRO I. Selecting a stent retriever (SR) that optimizes 90-day mRS score is an important consideration from both a clinical and healthcare payer perspective in China as it is associated with reduced long-term costs and increased quality of life.
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Plain language summary
What is this article about?
Mechanical thrombectomy (MT) using stent retrievers (SRs) is strongly recommended by the Chinese Stroke Association for the treatment of acute ischemic stroke (AIS) in eligible patients in China. MASTRO I, a recently published systematic review and meta-analysis, compared outcomes following MT for three commonly used SRs (EmboTrap®, Solitaire™ and Trevo®) and found that the SR used during MT may impact functional outcomes. Data from MASTRO I indicated that compared with Solitaire and Trevo, MT with EmboTrap was associated with improved functional outcomes. As better functional outcomes may result in lower healthcare resource utilization, SR choice during MT may have downstream economic implications. Therefore, the aim of the current analysis was to compare the cost–effectiveness of EmboTrap, Solitaire and Trevo from the perspective of the Chinese healthcare system over a 10-year time horizon based on functional outcomes 90-day post-stroke reported in MASTRO I.
What were the results?
EmboTrap dominated Trevo and was cost-effective compared with Solitaire when assessed at willingness-to-pay (WTP) thresholds of 1, 1.5 and 3-times the 2022 China national gross domestic product (GDP) per capita.
What do the results mean?
The results of this analysis indicate that EmboTrap may offer better value for money compared with Solitaire and Trevo in the treatment of AIS and that the downstream economic consequences of SR selection during MT are an important consideration from a clinical and healthcare payer perspective.
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Received: 8 August 2024
Accepted: 23 September 2024
Published online: 5 November 2024
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The economic impact associated with stent retriever selection for the treatment of acute ischemic stroke: a cost–effectiveness analysis of MASTRO I data from a Chinese healthcare system perspective. (2024) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0160
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Citing Literature
- Stent Retriever Thrombectomy in Acute Ischemic Stroke and Large Vessel Occlusion: Scoping Review with ☸️SAIMSARA, SAIMSARA Journal, 10.62487/saimsara1e6b954c, 1, 1, (2026).