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

Kunz, Wolfgang G; Hunink, Myriam G; Almekhlafi, Mohammed A; Menon, Bijoy K; Saver, Jeffrey L; Dippel, Diederik W J; Majoie, Charles B L M; Jovin, Tudor G; Davalos, Antoni; Bracard, Serge; Guillemin, Francis; Campbell, Bruce C V; Mitchell, Peter J; White, Philip; Muir, Keith W; Brown, Scott; Demchuk, Andrew M; Hill, Michael D; Goyal, Mayank

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-related costs yet over a shorter time span due to their shorter life expectancy, resulting in similar lifetime costs as in patients with early treatment. Regarding the economic value of care, every 10 minutes of earlier treatment increased the NMB by $10,593 (95% prediction interval: $5,549-$14,847) and by $10,915 (95% prediction interval: $5,928-$15,356) taking healthcare and societal perspectives, respectively. CONCLUSIONS Any time delay to EVT reduces QALYs and decreases the economic value of care provided by this intervention. Healthcare policies to implement efficient pre-hospital triage and accelerate in-hospital workflow are urgently needed.