Abstract
Purpose
The benefits of using mechanical thrombectomy (MT) to treat large vessel occlusion stroke in terms of clinical efficacy and cost-effectiveness have been widely recognised. However, the cost of delivering MT to treat large vessel occlusion stroke in private tertiary care centres in India is unclear. This study aimed to determine the cost of MT and analyse cost-influencing factors.
Methods
A retrospective cost analysis of stroke patients who underwent MT with or without intravenous thrombolysis (IVT) was conducted at multiple centres (January–December 2022). The macro-costing method was used to examine the discharge bills and identify cost-influencing factors. The study gathered data on patients treated according to normal clinical procedures at four skilled and frequently performing thrombectomy centres.
Results
The study was conducted on 115 stroke patients who underwent MT with or without IVT. Results showed an average total cost of ₹555,399 (95% confidence interval: 246,306–864,492) per patient. Key cost drivers were length of hospital stay (9.7 ± 7.0 days, p < .01), modified Rankin Scale (mRS) score at discharge (3.6 ± 1.6, p < .01) and use of decompressive surgery (10.7/115, p < .03). Lower costs were seen in patients with mRS scores 1, 2 or 6 on day 3 after MT (57/115, 50.4%, p < .01). Neither MT type nor concomitant use of IVT had a significant cost impact.
Conclusion
In conclusion, the mRS score is a critical factor in determining the cost of acute stroke therapy with MT in India. Efforts must be made to identify patients with poor mRS as early as 3 days after MT and devise a strategy to reduce their stay in the ICU and in the hospital, which would, in turn, help reduce their hospitalisation costs. It is crucial to gather accurate and comprehensive data on micro-costing to inform policies and allocate resources effectively.
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