The economic impact of stent retriever selection for acute ischemic stroke: a cost analysis of MASTRO I from the healthcare system perspective of the United States, Canada and eight European countries
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: According to the results of the MASTRO I living systematic review and meta-analysis, use of the EmboTrap Revascularization® Device in the treatment of acute ischemic stroke (AIS) results in higher rates of good functional outcomes (90-day modified Rankin Scale [mRS] 0–2) compared with use of the Trevo® Retriever or the Solitaire™ Revascularization Device. The aim of this analysis was to assess the potential economic impact of achieving improved functional outcomes for three commonly used stent retrievers (SRs) in the treatment of AIS. Methods: An economic model with short-term and long-term costs, representing a healthcare system perspective was developed using a decision tree to simulate a cohort of 1000 hypothetical patients treated for AIS with mechanical thrombectomy (MT) using EmboTrap, Trevo or Solitaire SRs. Based on the proportion of patients who achieved a 90-day mRS score of 0–2 or 3–5 for each device reported in MASTRO I (excluding patients not surviving after 90 days), this model estimated per-patient costs and the associated incremental cost savings. Results are reported from the healthcare system perspective in the US, Canada, the UK, Sweden, Germany, France, Italy, Spain, Belgium and The Netherlands. Results: Across all ten countries, the use of EmboTrap during MT was associated with the lowest short-term (ranging from €8412 in Italy to $66,525 in the US), long-term (ranging from €5249 in Italy to $25,757 in the US) and total (ranging from €13,661 in Italy to $92,282 in the US) per-patient costs. The total per-patient cost was higher with Trevo (ranging from €14,601 in Italy to $97,487 in the US) and Solitaire (ranging from €14,840 in Italy to $98,814 in the US). Cost savings were highest when comparing EmboTrap versus Solitaire, followed by EmboTrap versus Trevo, with Trevo versus Solitaire having the smallest cost savings. Results of sensitivity and scenario analyses supported the robustness of the base-case results. Conclusion: Across the ten countries, treating patients with AIS with EmboTrap resulted in lower short-term, long-term and total costs to the payer. With rising healthcare costs and limited hospital budgets, these results suggest EmboTrap proves to be an evidence-based economical choice of SR for hospitals and healthcare systems.
Plain language summary
What is this article about?
Mechanical thrombectomy (MT) is the current standard of care for the treatment of acute ischemic stroke and can be performed using stent retrievers (SRs), aspiration catheters or a combination of both. MASTRO I, a recently published systematic review and meta-analysis, compared outcomes following MT for three commonly used SRs (EmboTrap Revascularization® Device, Trevo® Retriever and Solitaire™ Revascularization Device) and found that the SR used during MT can impact functional outcomes. Data from MASTRO I reported that compared with Trevo and Solitaire, treatment 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 total (short- and long-term) economic outcomes with the use of EmboTrap, Trevo and Solitaire in the US, Canada, the UK, Sweden, Germany, France, Italy, Spain, Belgium and The Netherlands.
What were the results?
EmboTrap use was associated with the lowest short-term, long-term and total costs in all ten countries evaluated, followed by Trevo and Solitaire.
What do the results mean?
These results may assist physicians and hospital stakeholders in supporting evidence-based decision making when selecting an optimal choice of SR for MT. The results from this analysis suggest that, beyond device cost, optimizing patient functional outcomes through device selection can impact downstream economic consequences across all ten countries studied.
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References
Papers of special note have been highlighted as: • of interest; •• of considerable interest
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Received: 13 November 2024
Accepted: 23 December 2024
Published online: 17 February 2025
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The economic impact of stent retriever selection for acute ischemic stroke: a cost analysis of MASTRO I from the healthcare system perspective of the United States, Canada and eight European countries. (2025) Journal of Comparative Effectiveness Research. DOI: 10.57264/cer-2024-0216
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