The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study.

Balami, Joyce S, Coughlan, Diamuid, White, Phil M, McMeekin, Peter, Flynn, Darren, Roffe, Christine, Natarajan, Indira, Chembala, Jayan, Nayak, Sanjeev, Wiggam, Ivan, Flynn, Peter, Simister, Robert, Sammaraiee, Yazen, Sims, Don, Nader, Kurdow, Dixit, Anand, Craig, Dawn, Lumley, Hannah, Rice, Stephen, Burgess, David, Foddy, Lisa, Hopkins, Emer, Hudson, Beverley, Jones, Rachael, James, Martin A, Buchan, Alastair M, Ford, Gary A and Gray, Alastair M (2020) The cost of providing mechanical thrombectomy in the UK NHS: a micro-costing study. Clinical medicine (London, England), 20 (3). e40-e45. ISSN 1473-4893. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

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Official URL: https://www.rcpjournals.org/content/clinmedicine

Abstract

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.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
WL Nervous system. Neurology
WN Medical imaging. Radiology
Divisions: Planned IP Care > Vascular
Related URLs:
Depositing User: Jamie Edgar
Date Deposited: 27 May 2020 08:51
Last Modified: 27 May 2020 08:51
URI: http://www.repository.uhblibrary.co.uk/id/eprint/3102

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