Delays to Thrombectomy for Stroke Shown to Reduce Quality-of-Life and Economic Outcomes

July 24, 2018—The Society of NeuroInterventional Surgery (SNIS) announced findings from a study using a Markov model of lifetime quality-adjusted life years (QALYs) in patients treated with endovascular thrombectomy (EVT) that showed that every 10 minutes of delayed care reduced a patient’s disability-free lifetime by approximately 40 days. The study, "Lifetime Quality-of-Life and Cost Consequences of Treatment Delays in Endovascular Thrombectomy for Stroke Based on HERMES Data," was presented at the SNIS 15th annual meeting held July 23–26 in San Francisco, California.

In addition to analyzing a patient’s QALY, the study evaluated health care and societal costs, which include losses of productivity and informal care given by family members.

The study found that time delays to EVT significantly reduce the economic value of stroke care. A time delay of 10 minutes reduced the net monetary benefit of EVT by approximately $10,000, for both health care system or societal perspectives. The economic value is defined as the amount of health expenditures needed to achieve QALYs for a patient in a particular health care setting. Net monetary benefit is an economic measure that accounts for the value of care by combining weighted QALYs and costs into one composite outcome, explained SNIS.

The investigators' recommendations for more immediate treatment include improving emergency medical services (EMS) protocols, as well as improving in-hospital workflow by notifying the hospital in advance to have the full stroke team ready when the patient arrives in the emergency room and by distributing tasks among a coordinated stroke team.

In the SNIS announcement, study investigator Wolfgang Kunz, MD, who presented the data, commented, “This study shows that time delays can have a significant impact on a patient and society. Significant time delays of on average 2 hours could be prevented in triage if EMS send patients with severe signs of stroke directly to a comprehensive or level 1 stroke center that provides EVT instead of the closest primary stroke center.” Dr. Kunz is a radiology resident at Ludwig-Maximilians-University in Munich, Germany.

The chair of the HERMES collaboration and senior investigator of the study, Mayank Goyal, MD, added, “Given the dramatic financial benefits to health care systems by increasing efficiency, there should now be greater impetus toward investment into processes and technologies that reduce onset to reperfusion times.” Dr. Goyal is neurointerventionalist at the University of Calgary in Calgary, Alberta.

In comments to Endovascular Today at the SNIS meeting, Dr. Goyal put the findings into practical perspective.

"With budget constraints and limitations, one needs data to justify expenditure," said Dr. Goyal. "We are providing data to illustrate, from a financial perspective, the importance of fixing our overall systems of care so that patients with large strokes have an opportunity to get to treatment earlier." These data indicate that it would be reasonable to spend $250 million to improve stroke systems of care in the United States, he continued. "We already had evidence to show that time is brain. Now we can say that time is money as well."

A separate analysis of data from HERMES evaluated the financial impact of achieving higher quality of reperfusion. "Improvement in TICI [Thrombolysis in Cerebral Infarction] score was associated with a significant improvement in outcome and financial benefit, indicating the value of further investment in achieving even better outcomes via advances in technology and training," said Dr. Goyal.

Next, the group aims to gather cost data from other countries in order to provide country-specific analyses and help inform decision-makers around the world regarding the financial impact of delays in stroke care.