P-018\u2005Cost effectiveness of endovascular stroke therapy. analysis from a colombian healthcare perspective

Abstract

Introduction To assess the cost-effectiveness of stent-retriever mechanical thrombectomy in combination with Intravenous Tissue Plasminogen Activator (IV-tPA) versus IV-tPA alone for the Treatment of Acute Ischaemic Stroke in Colombia. Materials and methods Clinical data were taken from the SWIFT PRIME clinical trial. A lifetime Markov state transition model defined by the modified Rankin Scale score was developed to estimate costs and health outcomes (life years gained and quality adjusted life years). A Colombian National Health System perspective (direct medical costs) was considered. Resource utilization was extracted from National Payment Manuals and databases of open access. Costs are expressed in Colombian Pesos (COP). Deterministic and probabilistic sensitivity analyses were performed. Results Stent-retriever thrombectomy with Intravenous Tissue Plasminogen Activator (IV-tPA) was associated with better outcomes (4.38 life years gained and 2.96 quality adjusted life years) and savings of COP $1,824,733 resulting in a dominant therapy over intravenous tissue plasminogen activator alone. A net monetary benefit of COP $66,005,604 was obtained considering a willingness-to-pay threshold of COP $69,081,720. Discussion The results were consistent with a previously published cost-effectiveness analysis and reinforce the likeliness of the selection of stent-retriever mechanical thrombectomy plus intravenous tissue plasminogen activator over intravenous tissue plasminogen activator alone. Conclusion Stent-retriever thrombectomy in combination with Intravenous Tissue Plasminogen Activator is a dominant alternative over intravenous tissue plasminogen activator alone (more effective and less costly) for the treatment of acute ischaemic stroke patients with large vessel occlusions in Colombia. Disclosures B. Pabon: 2; C; Medtronic. J. Tellez: 5; C; Medtronic. J. Arcos: 5; C; Medtronic. P. Guijarro: 2; C; Medtronic. C. Diaz: None.