New stroke treatment proves effective, both medically and financially

January 4, 2017 by David Orenstein  
In this illustration a clot in the brain deprives the grayed out area of blood supply. A new treatment appears cost-effective in treating the clots. National Institute of Neurological Disorders and Stroke. Credit: Brown University

As soon as possible after a stroke, a critical step is to eliminate the clot that caused it. While the current standard of care is to use "clot busting" tissue-type plasminogen activator drugs, recent studies have shown greater medical efficacy in combining the drugs with a "stent retriever" that mechanically opens the artery for a device to grab it and pull it out—a surgical procedure called "thrombectomy."

The question remained, however, of whether the added procedure was cost-effective. A new study co-authored by Theresa Shireman, professor of health services, policy and practice at the Brown University School of Public Health, found that it is. After higher initial costs, Shireman explains in the interview below, better outcomes for patients make -related care less costly in the long run.

Shireman was lead author of the study published in the journal Stroke.

To compare the cost-effectiveness of one treatment vs. another, what did you measure?

In general, new technologies or treatments in health care cost more than the existing standard of care. In cost-effectiveness analysis, the purpose is to judge the relative increase in costs against the presumably improved benefit or effect. There are occasions, however, where a new treatment provides greater benefit or effect at a lower cost. That is the case with the technology we analyzed.

How much more cost effective was treatment with the mechanical thrombectomy plus the drug than treatment with the drug alone?

In the case of the technology we assessed, it made the initial hospitalization for more expensive (the cost of actually doing the procedure) but patients improved so much in their stroke recovery that long-term costs were lower. In other words, patients' recovery with respect to physical function was so much better with stent retriever thrombectomy that they were less likely to need nursing home rehabilitation and longer . This saved money so that within 22 months, the higher procedure costs had been covered.

Does cost-effectiveness (rather than care effectiveness) matter to patients and their families or only to insurers and providers?

Cost-effectiveness should matter to all of us, as it is one approach to finding the most efficient health care interventions—those that generate the greatest benefit at the lowest cost. If we regularly find the most efficient interventions, we all will pay less for and have the best outcomes. In the case of stent retriever thrombectomy, it is easy to see the patient and family benefits, as they have better functional recovery post-stroke and are less likely to need nursing home care. That's a double-win for them and for payers and providers. In many cases, however, cost-effectiveness analyses may not generate such clear results, and not all analyses adhere to consensus guidelines.

How might these findings affect stroke treatment in the future?

For patients who suffer an ischemic stroke and are located close enough to a stroke center or hospital with the appropriately trained interventionist, access to stent retriever thrombectomy should be able to dramatically reduce the burden of stroke.

What was your role in the study?

The project was designed by Dr. David Cohen and his team at the Saint Luke's Mid-America Heart Institute in Kansas City, Missouri. I served as the lead investigator, shepherding the project through its various phases, reviewing intermediate steps, presenting the findings at an international conference and preparing the final manuscript.

Explore further: Some stroke treatments proven to reduce health care costs

More information: Theresa I. Shireman et al. Cost-Effectiveness of Solitaire Stent Retriever Thrombectomy for Acute Ischemic Stroke, Stroke (2016). DOI: 10.1161/STROKEAHA.116.014735

Related Stories

Some stroke treatments proven to reduce health care costs

July 27, 2015

Use of mechanical thrombectomy on qualifying stroke patients could result in major savings to the healthcare economy in the United Kingdom (U.K.) and other western countries with a similar healthcare structure, according ...

Clot removal may save money and limit disability

February 17, 2016

Adding mechanical clot removal to clot-busting drugs could lower stroke survivors medical bills, decrease government healthcare as well as non-healthcare related costs, and increase the likelihood of the patient returning ...

New devices causing 'paradigm shift' in stroke care

June 24, 2016

New devices called stent retrievers, which effectively reverse strokes, have revolutionized the treatment of certain stroke patients, according to an article in the journal Expert Review of Neurotherapeutics.

Recommended for you

Macrophages shown to be essential to a healthy heart rhythm

April 20, 2017

A Massachusetts General Hospital (MGH)-led research team has identified a surprising new role for macrophages, the white blood cells primarily known for removing pathogens, cellular debris and other unwanted materials. In ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.