ABSTRACT NUMBER: ESOC2026A1878 COST-EFFECTIVENESS OF INTERVENTIONS THAT IMPROVE THE FIRST PASS REPERFUSION RATE IN ACUTE ISCHEMIC STROKE: A MARKOV DECISION ANALYSIS

Abstract Background and aims First pass reperfusion (FPR) has been shown to double the likelihood of functional independence after acute ischemic stroke (AIS). However, strategies to improve FPR rate can be costly. In this study, we evaluated the maximum cost for a new strategy aiming to increase the rate of FPR such that it is net cost-effective. Methods We developed a cost-effectiveness framework using a Markov based simulation involving 2.3 million virtual patients followed over a 20-year time horizon. Clinical inputs, including procedural success, complications, disability trajectories, recurrent stroke risk, and chronic care costs, were taken from the MRCLEAN registry, with intervention-specific improvements in FPR modeled as the primary variable affecting functional outcomes. The outputs of this simulation were implemented into a cost-effectiveness formula with expected increases in FPR and the cost of a new intervention as variables to determine whether the implementation of this new intervention is cost-effective under Dutch standard willingness-to-pay thresholds. Results The framework shows that achieving FPR can increase a person’s quality of life years (QALY) by 0.89 year. Hence, an intervention that increases the rate of FPR by α% is cost effective if it costs less than €712*α per patient. For example, an improvement of 10% in FPR is cost effective if its price is less than €7,120 per use. Conclusions Even modest improvements in FPR can yield substantial long-term benefits by reducing disability and the need for institutional care. The developed cost-effectiveness formula is a practical tool for assessing the potential value of rapidly emerging thrombectomy technologies. Conflict of interest Gerard van Spaendonck: nothing to disclose