Maheswaran, Hendramoorthy

Background Balloon guide catheters (BGCs) are adjunctive devices that may be used during mechanical thrombectomy (MT) to induce flow arrest and improve clot retrieval and reperfusion outcomes for acute ischemic stroke. As the cost-effectiveness of BGC use remains uncertain, this study assessed short- and long-term direct healthcare costs associated with BGC use versus standard guide catheters (SGC) during MT. Methods A decision tree model estimated the short-term costs (index hospitalization), long-term costs (one year after index hospitalization), and total costs for patients undergoing MT + BGC versus MT + SGC from a healthcare system perspective in the United States (US), Canada, United Kingdom (UK), Sweden, Germany, Italy, Spain, Belgium, and The Netherlands. Average device costs were sourced from public tender prices and market research data. Weighted average healthcare costs for modified Rankin Scale scores were sourced from published literature for the respective countries. A 2024 meta-analysis supporting improved outcomes with BGC provided input parameters to model treatment effects for BGC and SGC. Deterministic one-way and probabilistic sensitivity analyses evaluated the robustness of model parameters and accounted for uncertainty. Results Across all countries, long-term and total per-patient costs were lower with MT + BGC, yielding total per-patient cost savings of $6297 (US), CAD 3006 (Canada), £1828 (UK), 28,950 kr (Sweden), €1077 (Germany), €709 (Italy), €3678 (Spain), €2259 (Belgium), and €3344 (The Netherlands). The probability of MT + BGC yielding cost savings ranged 0.356–0.911 (short term), 0.962–0.975 (long term), and 0.838–0.935 (total costs). While long-term and total costs consistently favored MT + BGC, short-term cost savings showed more variability across countries. Conclusion This study demonstrates that BGC use is associated with total one-year per-patient cost savings for inpatient and postdischarge stroke care across the US, Canada, and seven European healthcare systems. Balloon guide catheters can potentially reduce post-stroke care costs and should be considered more broadly, despite the additional cost incurred by the device.

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.