RT Journal Article
SR Electronic
T1 The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP e40
OP e45
DO 10.7861/clinmed.2019-0413
VO 20
IS 3
A1 Joyce S Balami
A1 Diamuid Coughlan
A1 Phil M White
A1 Peter McMeekin
A1 Darren Flynn
A1 Christine Roffe
A1 Indira Natarajan
A1 Jayan Chembala
A1 Sanjeev Nayak
A1 Ivan Wiggam
A1 Peter Flynn
A1 Robert Simister
A1 Yazen Sammaraiee
A1 Don Sims
A1 Kurdow Nader
A1 Anand Dixit
A1 Dawn Craig
A1 Hannah Lumley
A1 Stephen Rice
A1 David Burgess
A1 Lisa Foddy
A1 Emer Hopkins
A1 Beverley Hudson
A1 Rachael Jones
A1 Martin A James
A1 Alastair M Buchan
A1 Gary A Ford
A1 Alastair M Gray
YR 2020
UL http://www.rcpjournals.org/content/20/3/e40.abstract
AB Introduction The clinical efficacy and cost-effectiveness of mechanical thrombectomy (MT) for the treatment of large vessel occlusion stroke is well established, but uncertainty remains around the true cost of delivering this treatment within the NHS. The aim of this study was to establish the cost of providing MT within the hyperacute phase of care and to explore differences in resources used and costs across different neuroscience centres in the UK.Method This was a multicentre retrospective study using micro-costing methods to enable a precise assessment of the costs of MT from an NHS perspective. Data on resources used and their costs were collected from five UK neuroscience centres between 2015 and 2018.Results Data were collected on 310 patients with acute ischaemic stroke treated with MT. The mean total cost of providing MT and inpatient care within 24 hours was £10,846 (95% confidence interval (CI) 10,527–11,165) per patient. The main driver of cost was MT procedure costs, accounting for 73% (£7,943; 95% CI 7,649–8,237) of the total 24-hour cost. Costs were higher for patients treated under general anaesthesia (£11,048; standard deviation (SD) 2,654) than for local anaesthesia (£9,978; SD 2,654), mean difference £1,070 (95% CI 381–1,759; p=0.003); admission to an intensive care unit (ICU; £12,212; SD 3,028) against for admission elsewhere (£10,179; SD 2,415), mean difference £2,032 (95% CI 1,345–2,719; p<0001).The mean cost within 72 hours was £12,440 (95% CI 10,628–14,252). The total costs for the duration of inpatient care before discharge from a thrombectomy centre was £14,362 (95% CI 13,603–15,122).Conclusions Major factors contributing to costs of MT for stroke include consumables and staff for intervention, use of general anaesthesia and ICU admissions. These findings can inform the reimbursement, provision and strategic planning of stroke services and aid future economic evaluations.