***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Mechanical thrombectomy has the potential to improve recanalization rates and outcomes for patients with ischemic stroke , but potential gains could be offset by procedural complications and costs . We evaluated the cost and utility of combined intravenous ( IV ) tissue-type plasminogen activator ( tPA ) and mechanical thrombectomy compared to IV tPA alone for acute large-vessel ischemic stroke . Methods — We constructed a decision tree for a hypothetical 68-year-old with a large-vessel ischemic stroke who is eligible for IV tPA . The interventional strategy was IV tPA , a cerebral angiogram , and mechanical thrombectomy and thrombolysis if indicated . Recanalization , hemorrhage complications , and outcomes for the interventional strategy were from the Multi-MERCI study . The medical strategy was IV tPA using inputs from a comprehensive systematic review . Costs were estimated from Medicare reimbursements . We modeled lifetime costs and utilities for disability using a Markov model and Monte-Carlo multivariable sensitivity analysis . Results — For the baseline scenario , the recanalization rate was 72.9 % for the interventional strategy and 46.2 % for the medical strategy . For the interventional strategy , the symptomatic hemorrhage rate was 8.6 % with recanalization and 15.4 % without . For the medical strategy , the corresponding rates were 3.6 % and 13.3 % , respectively . The interventional strategy was cost-effective in 97.6 % of simulations ( incremental cost-effectiveness ratio $ 16 001/ quality -adjusted life year ; 95 % CI , $ 2736–$39 232 ) . Conclusions — Based on observational data , the combination of IV tPA and mechanical thrombectomy for large-vessel ischemic stroke appears to be cost-effective compared to IV tPA alone . These findings require additional validation with r and omized trial data Background and Purpose — Clinical trials have demonstrated improved 90-day outcomes for patients with acute ischemic stroke treated with stent retriever thrombectomy plus tissue-type plasminogen activator ( SST+tPA )  compared with tPA . Previous studies suggested that this strategy may be cost-effective , but models were derived from pooled data and older assumptions . Methods — In this prospect i ve economic sub study conducted alongside the SWIFT-PRIME trial ( Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke ) , in-trial costs were measured for patients using detailed medical re source utilization and hospital billing data . Utility weights were assessed at 30 and 90 days using the EuroQol-5 dimension question naire . Post-trial costs and life-expectancy were estimated for each surviving patient using a model based on trial data and inputs derived from a contemporary cohort of ischemic stroke survivors . Results — Index hospitalization costs were $ 17 183 per patient higher for SST+tPA than for tPA ( $ 45 761 versus $ 28 578 ; P<0.001 ) , driven by initial procedure costs . Between discharge and 90 days , costs were $ 4904 per patient lower for SST+tPA than for tPA ( $ 11 270 versus $ 16 174 ; P=0.014 ) ; total 90-day costs remained higher with SST+tPA ( $ 57 031 versus $ 44 752 ; P<0.001 ) . Higher utility values for SST+tPA led to higher in-trial quality -adjusted life years ( 0.131 versus 0.105 ; P=0.005 ) . In lifetime projections , SST+tPA was associated with substantial gains in quality -adjusted life years ( 6.79 versus 5.05 ) , cost savings of $ 23 203 per patient and was economically dominant when compared with tPA in 90 % of bootstrap replicates . Conclusions — Among patients with acute ischemic stroke enrolled in the SWIFT-PRIME trial , SST increased initial treatment costs , but was projected to improve quality -adjusted life-expectancy and reduce healthcare costs over a lifetime horizon compared with tPA . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01657461 Objective : To evaluate the cost-effectiveness of adding endovascular thrombectomy to st and ard care in patients with acute ischemic stroke . Methods : The cost-effectiveness analysis of endovascular thrombectomy in patients with acute ischemic stroke was based on a decision-analytic Markov model . Primary outcomes from ESCAPE , Extending the Time for Thrombolysis in Emergency Neurological Deficits – Intra-Arterial ( EXTEND-IA ) , Multicenter R and omized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherl and s ( MR CLEAN ) , Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours ( REVASCAT ) , and Solitaire with the Intention for Thrombectomy as Primary Endovascular Treatment for Acute Ischemic Stroke ( SWIFT PRIME ) along with data from published studies and registries were used in this analysis . We used a health care payer perspective and a lifelong time horizon to estimate costs and effects . Results : The model showed that adding thrombectomy with stent retrievers to guideline -based care ( including IV thrombolysis ) result ed in a gain of 0.40 life-years and 0.99 quality -adjusted life-years along with a cost savings of approximately $ 221 per patient . The sensitivity analysis showed that the results were not sensitive to changes in uncertain parameters or assumptions . Conclusions : Adding endovascular treatment to st and ard care result ed in substantial clinical benefits at low costs . The results were consistent throughout irrespective of whether data from ESCAPE , EXTEND-IA , MR CLEAN , REVASCAT , or SWIFT PRIME were used in this model OBJECT Mechanical thrombectomy is increasingly being used for the treatment of large-vessel ischemic stroke in patients who arrive outside of the 3-hour tissue plasminogen activator time window . In this study , the authors evaluated the cost and effectiveness of mechanical thrombectomy compared with st and ard medical therapy in patients who are ineligible to receive tissue plasminogen activator . METHODS Clinical outcomes of an open-label study of mechanical thrombectomy were compared with a hypothetical control group with a lower recanalization rate ( 18 vs 60 % ) and a lower rate of symptomatic intracranial hemorrhage ( 0.6 vs 7.8 % ) than the active treatment group . A Markov cost-effectiveness model was built to compare the health benefits and costs associated with mechanical thrombectomy compared with st and ard medical therapy . All probabilities , quality -of-life factors , and costs were estimated from the published literature . Univariate sensitivity analyses were performed to assess how variations in model parameters affect health and economic outcomes . RESULTS Treatment of acute ischemic stroke with mechanical thrombectomy increased survival time by 0.54 quality -adjusted life years ( QALYs ) , compared with st and ard medical therapy ( 2.37 vs 1.83 QALYs ) , at an increased cost of $ 6600 . This yielded an incremental cost-effectiveness ratio ( ICER ) of $ 12,120 per QALY gained , a value generally considered cost-effective . Sensitivity analysis showed that mechanical thrombectomy remained cost-effective ( ICER < $ 50,000 per QALY gained ) for all model inputs varied over a reasonable range , except for age at stroke treatment . For patients older than 82 years of age , the treatment was only borderline cost-effective ( ICER of $ 50,000 - 100,000 per QALY gained ) . CONCLUSIONS The treatment of large-vessel ischemic stroke with mechanical thrombectomy appears to be costeffective . These results require validation when data from a r and omized , controlled trial of mechanical thrombectomy become available Background and Purpose — The objective of this study was to determine the cost-effectiveness of intra-arterial treatment within the 0- to 6-hour window after intravenous tissue-type plasminogen activator within 0- to 4.5-hour compared with intravenous tissue-type plasminogen activator alone , in the US setting and from a social perspective . Methods — A decision analytic model estimated the lifetime costs and outcomes associated with the additional benefit of intra-arterial therapy compared with st and ard treatment with intravenous tissue-type plasminogen activator alone . Model inputs were obtained from published literature , the Multicenter R and omized Clinical Trial of Endovascular Therapy for Acute Ischemic Stroke in the Netherl and s ( MR CLEAN ) study , and cl aims data bases in the United States .  Health outcomes were measured in quality -adjusted life years ( QALYs ) . Treatment benefit was assessed by calculating the cost per QALY gained . One-way and probabilistic sensitivity analyses were performed to estimate the overall uncertainty of model results . Results — The addition of intra-arterial therapy compared with st and ard treatment alone yielded a lifetime gain of 0.7 QALY for an additional cost of $ 9911 , which result ed in a cost of $ 14 137 per QALY . Multivariable sensitivity analysis predicted cost-effectiveness ( ⩽$50 000 per QALY ) in 97.6 % of simulation runs . Conclusions — Intra-arterial treatment after intravenous tissue-type plasminogen activator for patients with anterior circulation strokes within the 6-hour window is likely cost-effective . From a societal perspective , increased investment in access to intra-arterial treatment for acute stroke may be justified BACKGROUND AND PURPOSE : It is unclear whether the costs and risks of mechanical therapies make them cost-effective . We examined whether interventions such as mechanical clot removal or disruption with angioplasty are cost-effective for acute ischemic stroke compared with best medical therapy . MATERIAL S AND METHODS : We performed a cost-utility analysis of patients with acute stroke due to large intracranial artery occlusion presenting beyond the 3-hour window for IV tPA .  Model inputs for the mechanical arm were derived from Multi MERCI trial data and a recent meta- analysis . For best medical therapy , we used rates of spontaneous recanalization , ICH , and functional outcomes based on a systematic literature review . Discounted QALYs were determined by using the Markov modeling for 65-year-old patients with acute ischemic stroke . RESULTS : On the basis of a systematic literature review , we modeled an 84 % rate of recanalization with mechanical intervention and a 6.3 % rate of symptomatic ICH . For best medical therapy , we modeled a spontaneous recanalization rate of 24 % with a 2 % rate of symptomatic ICH . Mechanical therapies were associated with a $ 7718 net cost and a gain of a 0.82 QALYs for each use , thus yielding a net of $ 9386/QALY gained . In sensitivity analyses , results were dependent on the rates of recanalization , symptomatic ICH rates , and costs of treatment . CONCLUSIONS : On the basis of available data , mechanical therapies in qualified patients with acute stroke beyond the window for IV tPA appear to be cost-effective . However , the inputs are not derived from r and omized trials , and results are sensitive to several assumptions BACKGROUND Thrombolytic therapy for acute ischemic stroke has been approached cautiously because there were high rates of intracerebral hemorrhage in early clinical trials . We performed a r and omized , double-blind trial of intravenous recombinant tissue plasminogen activator ( t-PA ) for ischemic stroke after recent pilot studies suggested that t-PA was beneficial when treatment was begun within three hours of the onset of stroke . METHODS The trial had two parts . Part 1 ( in which 291 patients were enrolled ) tested whether t-PA had clinical activity , as indicated by an improvement of 4 points over base-line values in the score of the National Institutes of Health stroke scale ( NIHSS ) or the resolution of the neurologic deficit within 24 hours of the onset of stroke . Part 2 ( in which 333 patients were enrolled ) used a global test statistic to assess clinical outcome at three months , according to scores on the Barthel index , modified Rankin scale , Glasgow outcome scale , and NIHSS : RESULTS In part 1 , there was no significant difference between the group given t-PA and that given placebo in the percentages of patients with neurologic improvement at 24 hours , although a benefit was observed for the t-PA group at three months for all four outcome measures . In part 2 , the long-term clinical benefit of t-PA predicted by the results of part 1 was confirmed ( global odds ratio for a favorable outcome , 1.7 ; 95 percent confidence interval , 1.2 to 2.6 ) . As compared with patients given placebo , patients treated with t-PA were at least 30 percent more likely to have minimal or no disability at three months on the assessment scales . Symptomatic intracerebral hemorrhage within 36 hours after the onset of stroke occurred in 6.4 percent of patients given t-PA but only 0.6 percent of patients given placebo ( P < 0.001 ) . Mortality at three months was 17 percent in the t-PA group and 21 percent in the placebo group ( P = 0.30 ) . CONCLUSIONS Despite an increased incidence of symptomatic intracerebral hemorrhage , treatment with intraven 
    Output:
    
Conclusions If the outcomes of the trials underpinning the evidence of clinical effectiveness can be replicated , then mechanical thrombectomy is likely to be cost-effective by typical willingness-to-pay thresholds .
This finding holds under the assumption that no investment is required to develop stroke centres to the st and ard required to provide a safe emergency endovascular service and that additional expenditure on timely patient transport is not required