Cost-effectiveness of mechanical thrombectomy for treatment of nonminor ischemic stroke across Europe

Paolo Candio, Mara Violato, Jose Leal, Ramon Luengo-Fernandez

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Background and Purpose: Mechanical thrombectomy (MT) has been recommended for the treatment of nonminor ischemic stroke by national and international guidelines, but cost-effectiveness evidence has been generated for only a few countries using heterogeneous evaluation methods. We estimate the cost-effectiveness of MT across 32 European countries.

Methods: A Markov model was developed to estimate the cost-effectiveness of MT compared with standard care over a 5-year time horizon. Patients with ischemic stroke eligible for MT were identified from 2017 country-specific incidence data. A societal perspective was adopted, including health, social, and informal care costs, and productivity losses. Model outcomes were expressed as quality-adjusted life years. Sensitivity analyses were conducted to test the robustness of findings.

Results: We identified 267 514 ischemic stroke cases that were eligible for MT treatment across 32 European countries. MT was found to be more effective and cheaper than standard care in two-thirds of the countries (21/32) and cost-effective in all but one country (Bulgaria). Across Europe, the intervention was estimated to produce over 101 327 additional quality-adjusted life years (95% uncertainty interval, 65 180–149 085) and cost savings of $981 million (€868 million, 95% uncertainty interval, −1544 to 2564) and of $1.7 billion (€1.5 billion, 95% uncertainty interval, −1.2 to 3.6) in health and social care and societal costs, respectively.

Conclusions: MT is highly likely to be cost-effective compared with standard care across Europe as a whole and in the vast majority of European countries.
Original languageEnglish
Pages (from-to)664–673
Number of pages10
Issue number2
Early online date11 Jan 2021
Publication statusPublished - Feb 2021


  • thrombectomy
  • quality-adjusted life years
  • ischemic stroke
  • guideline
  • Europe
  • cost-effectiveness


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