Public health and cost consequences of time delays to thrombectomy for acute ischemic stroke

Objective: To determine public health and cost consequences of time delays to EVT for patients, healthcare systems, and society, we estimated quality-adjusted life years (QALY) of EVT-treated patients and associated costs based on times to treatment.

Methods: The Markov model analysis was performed from United States healthcare and societal perspectives over a lifetime horizon. Contemporary data from seven trials within the HERMES collaboration served as data source. Aside from cumulative lifetime costs, we calculated the net monetary benefit (NMB) to determine the economic value of care. We used a contemporary willingness-to-pay threshold of $100,000 per QALY for NMB calculations.

Results: Every 10 minutes of earlier treatment resulted in an average gain of 39 days (95% prediction interval: 23-53 days) of disability-free life. Overall, the cumulative lifetime costs for patients with earlier or later treatment were similar. Patients with later treatment had higher morbidity-relate...