Cost-Effectiveness of Magnetic Resonance Imaging for Guiding Intravenous Thrombolysis in Acute Ischemic Stroke

Motivation: MRI has been shown to identify patients with salvageable brain tissue in stroke patients presenting with unknown onset. The WAKE-UP trial demonstrated a clinical benefit of such MRI-guided IV thrombolysis (IVT) over best supportive care (BSC). Goal(s): We aimed to determine the cost-effectiveness of this management strategy. Approach: A decision model based on Markov simulations estimated lifetime costs and quality-adjusted life years (QALY) associated with MRI-guided IVT or BSC. Results: The base-case analysis identified MRI-guided IVT as the strategy that resulted in incremental QALYs and cost-savings over the projected lifetime compared to BSC (IC: -$21,481; IE: +0.62 QALYs; ICER: IVT dominant). Impact: MRI-guided IVT is projected to provide long-term clinical benefit whilst also leading to cost-savings in the management of stroke patients with unknown onset. Based on the projected health and cost benefits, investments to support the required MRI infrastructure are justified.