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

Joyce S. Balami*, Diamuid Coughlan, Phil M. White, Peter McMeekin, Darren Flynn, Christine Roffe, Indira Natarajan, Jayan Chembala, Sanjeev Nayak, Ivan Wiggam, Peter Flynn, Robert Simister, Yazen Sammaraiee, Don Sims, Kurdow Nader, Anand Dixit, Dawn Craig, Hannah Lumley, Stephen Rice, David BurgessLisa Foddy, Emer Hopkins, Beverley Hudson, Rachael Jones, Martin A. James, Alastair M. Buchan, Gary A. Ford, Alastair M. Gray

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)E40-E45
Number of pages6
JournalClinical Medicine, Journal of the Royal College of Physicians of London
Issue number3
Publication statusPublished - 1 May 2020

Bibliographical note

Funding Information:
Alastair Gray is partly funded by the NIHR Oxford Biomedical Research Centre. Phil White has undertaken consultancy work for Stryker, Codman and MicroVention who manufacture stroke thrombectomy devices. Gary Ford has received personal remuneration for educational and advisory work from Amgen, Daiichi Sankyo, Medtronic, Pfizer and Stryker; and his institution has received educational grants from Medtronic and Pfizer for stroke related activities. Martin James has received honoraria and support for educational activities from Boehringer Ingelheim and Medtronic. Joyce Balami has received a travel grant from Kellogg College, University of Oxford. Alastair Buchan is partly funded by the NIHR Oxford Biomedical Research Centre and is senior medical science advisor and co-founder of Brainomix, a company that develops electronic ASPECTS (e-ASPECTS). Robert Simister is partly funded by the NIHR University College London Hospitals Biomedical Research Centre. Christine Roffe has received personal remuneration for educational and advisory work from Allergan and Daiichi Sankyo and her institution has received educational grants from Medtronic, Brainomix, Firstkind Medical and Johnson & Johnson for stroke-related activities. She was the national coordinator for the ECASS-4 study and is the national lead for SITS International, both of which are partially funded by Boehringer Ingelheim.

Funding Information:
This report is independent research supported by the NIHR Applied Research Collaboration South West Peninsula (PenARC). The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

Publisher Copyright:
© Royal College of Physicians 2020. All rights reserved.


  • Acute ischaemic stroke
  • Costs
  • Mechanical thrombectomy
  • Micro-costing
  • Treatment

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