How a thrombectomy service can reduce hospital deficit: a cost-effectiveness study

Grunwald, Iris Q.; Wagner, Viola; Podlasek, Anna; Koduri, Gouri; Guyler, Paul; Gerry, Stephen; Shah, Sweni; Sievert, Horst; Sharma, Aarti; Mathur, Shrey; Fassbender, Klaus; Shariat, Kaveh; Houston, Graeme; Kanodia, Avinash; Walter, Silke

Abstract

Background: There is level 1 evidence for cerebral thrombectomy with thrombolysis in acute large vessel occlusion. Many hospitals are now contemplating setting up this life-saving service. For the hospital, however, the first treatment is associated with an initial high cost to cover the procedure. Whilst the health economic benefit of treating stroke is documented, this is the only study to date performing matched-pair, patient-level costing to determine treatment cost within the first hospital episode and up to 90days post-event. Methods: We conducted a retrospective coarsened exact matched-pair analysis of 50 acute stroke patients eligible for thrombectomy. Results: Thrombectomy resulted in significantly more good outcomes (mRS 0–2) compared to matched controls (56% vs 8%, p = 0.001). More patients in the thrombectomy group could be discharged home (60% vs 28%), fewer were discharged to nursing homes (4% vs 16%), residential homes (0% vs 12%) or rehabilitation centres (8% vs 20%). Thrombectomy patients had fewer serious adverse events (n = 30 vs 86) and were, on average, discharged 36days earlier. They required significantly fewer physiotherapy sessions (18.72 vs 46.49, p = 0.0009) resulting in a median reduction in total rehabilitation cost of £4982 (p = 0.0002) per patient. The total cost of additional investigations was £227 lower (p = 0.0369). Overall, the median cost without thrombectomy was £39,664 per case vs £22,444, resulting in median savings of £17,221 (p = 0.0489). Conclusions: Mechanical thrombectomy improved patient outcome, reduced length of hospitalisation and, even without procedural reimbursement, significantly reduced cost to the thrombectomy providing hospital.

Citation

Grunwald, I. Q., Wagner, V., Podlasek, A., Koduri, G., Guyler, P., Gerry, S., Shah, S., Sievert, H., Sharma, A., Mathur, S., Fassbender, K., Shariat, K., Houston, G., Kanodia, A., & Walter, S. (2022). How a thrombectomy service can reduce hospital deficit: a cost-effectiveness study. Cost Effectiveness and Resource Allocation, 20(1), Article 59. https://doi.org/10.1186/s12962-022-00395-8

• Journal Article Type: Article
• Acceptance Date: Oct 17, 2022
• Online Publication Date: Nov 4, 2022
• Publication Date: Nov 4, 2022
• Deposit Date: Jun 9, 2023
• Publicly Available Date: Jun 14, 2023
• Journal: Cost Effectiveness and Resource Allocation
• Electronic ISSN: 1478-7547
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• Volume: 20
• Issue: 1
• Article Number: 59
• DOI: https://doi.org/10.1186/s12962-022-00395-8
• Public URL: https://nottingham-repository.worktribe.com/output/21645745
• Publisher URL: https://resource-allocation.biomedcentral.com/articles/10.1186/s12962-022-00395-8
• Additional Information: Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.