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Adding intra-arterial administration of thrombolytics or mechanical clot removal to standard clot-busting medication for anterior circulation proximal occlusion strokes appeared cost-effective in an analysis.

The extra treatment given within 6 hours of stroke onset cost , based on adding an average $9,911 to the tab for care for the gain of 0.7 lifetime QALYs, , of the University of Colorado in Aurora, and colleagues found.

More than 97% of multivariable sensitivity analyses turned up cost-effectiveness within the $50,000 per QALY threshold, they reported in the July issue of Stroke.

"This suggests that even costly investments in the capital needed to support intra-arterial therapy systems of care (e.g., telemedicine, transport networks) may also be good investments from a societal perspective," the group suggested.

Prior analyses has also suggested cost effectiveness of intra-arterial treatment but had to rely on projections from revascularization rates, rather than the actual functional outcomes that have become known recently through trials like MR CLEAN and others that have given what many are calling a clear mandate for practice.

"From a societal perspective, we will have to start changing the mindset behind stroke care," Leppert's group concluded. "Providers can no longer stop at administering intravenous tPA [tissue plasminogen activator], but patients with suspected anterior infarcts must also have vessel imaging to see whether they would be a candidate for intra-arterial therapy. Furthermore, it will involve widening the network of comprehensive stroke centers so that patients meeting the criteria can have prompt access to intra-arterial therapy."

Their study modeling cost and outcome impacts based on published literature, the MR CLEAN study, and U.S. claims databases didn't "account for some important costs such as infrastructure, service redesign, or specialist training," they cautioned.

And those costs could be considerable if the interventions are to be provided over a wide geographic area, , chair of neurology at the University of Kentucky in Lexington, commented in an email to 番茄社区.

However, those impacts are likely to be small and accrue over time, noted , director of the Stern Stroke Center in New York City.

"Much of the infrastructure necessary (angiography suites) already exists for treating acute myocardial infarction," he told 番茄社区.

Public policy, education interventions, and telemedicine are all likely to be important components of improving the systems of care for intra-arterial treatment, , of the University of Pennsylvania in Philadelphia, pointed out.

"These are relatively low-cost interventions, and given the massive benefit of endovascular therapy for appropriately selected patients, I don't think that these factors will change the cost-effectiveness," he said in an email to 番茄社区.

If anything, the analysis might have been too conservative in estimating the societal impact, Labovitz added.

"Long-term rehabilitation or custodial care in a nursing home dwarfs physician costs, but is not accounted for in this analysis," he pointed out. "These are life-changing strokes and the stunning impact on quality of life when thrombectomy is successful cannot be overstated.

"It isn't just the patient -- family members benefit too with less time dedicated to providing care rather than working or relaxing. I have never seen a change in stroke treatment as dramatic as this one. The question is not whether we can afford the treatment. It is how quickly can we make it routinely available."

From the American Heart Association:

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