Background and Purpose—The benefit that endovascular thrombectomy offers to patients with stroke with large vessel occlusions depends strongly on reperfusion grade as defined by the expanded Thrombolysis in Cerebral Infarction (eTICI) scale. Our aim was to determine the lifetime health and cost consequences of the quality of reperfusion for patients, healthcare systems, and society.Methods—A Markov model estimated lifetime quality-adjusted life years (QALY) and lifetime costs of endovascular thrombectomy–treated patients with stroke based on eTICI grades. The analysis was performed over a lifetime horizon in a United States setting, adopting healthcare and societal perspectives. The reference case analysis was conducted for stroke at 65 years of age. National health and cost consequences of improved eTICI 2c/3 reperfusion rates were estimated. Input parameters were based on best available evidence.Results—Lifetime QALYs increased for every grade of improved reperfusion (median QALYs for eTICI 0/1: 2.62; eTICI 2a: 3.46; eTICI 2b: 5.42; eTICI 2c: 5.99; eTICI 3: 6.73). Achieving eTICI 3 over eTICI 2b reperfusion resulted on average in 1.31 incremental QALYs as well as healthcare and societal cost savings of $10 327 and $20 224 per patient. A 10% increase in the eTICI 2c/3 reperfusion rate of all annually endovascular thrombectomy–treated patients with stroke in the United States is estimated to yield additional 3656 QALYs and save $21.0 million and $36.8 million for the healthcare system and society, respectively.Conclusions—Improved reperfusion grants patients with stroke additional QALYs and leads to long-term cost savings. Procedural strategies to achieve complete reperfusion should be assessed for safety and feasibility, even when initial reperfusion seems to be adequate.

中文翻译：

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卒中血栓切除术后再灌注成功的公共卫生和成本效益。

背景和目的-血管内血栓切除术对患有大血管闭塞的中风患者的益处在很大程度上取决于再灌注级别，这由扩大的脑梗死溶栓术（eTICI）规模确定。我们的目的是确定再灌注质量对患者，医疗系统和社会的终生健康和费用后果。方法-马尔可夫模型估计经血管内血栓切除术治疗的患者的终生质量调整生命年（QALY）和终生费用。基于eTICI等级的中风。该分析是在美国的一生中采用医疗保健和社会观点进行的。在65岁时对中风进行了参考病例分析。估计了eTICI 2c / 3再灌注率提高对国家健康和成本的影响。输入参数基于可获得的最佳证据。结果-每种级别的再灌注改善的终生QALY均增加（eTICI 0/1的中位数QALY：2.62； eTICI 2a：3.46； eTICI 2b：5.42； eTICI 2c：5.99； eTICI 3：6.73 ）。与eTICI 2b再灌注相比，实现eTICI 3可以平均增加1.31 QALY，并且每位患者可节省10 327美元和20 224美元的医疗和社会成本。在美国，每年所有经血管内血栓切除术治疗的中风患者的eTICI 2c / 3再灌注率提高10％，估计可额外产生3656个QALY，分别为医疗系统和社会节省2100万美元和3680万美元。 -改善的再灌注可以使中风患者获得更多QALY，并可以长期节省成本。