Abstract
Introduction The Subcommittee for Development of the Benefit Package and Service Delivery (SCBP), which holds decision-making authority for the health benefit package of the Universal Coverage Scheme (UC), requested the Health Intervention and Technology Assessment Program (HITAP) to conduct a health technology assessment of “Endovascular treatment for acute ischemic stroke”. This information will be used by the SCBP to decide whether to include endovascular therapy in the UC benefit package. Objectives This study aims to determine the value for money and the fiscal burden to the Thai government of introducing endovascular treatment for acute ischemic stroke into the UC. We also review the feasibility of providing endovascular treatment in Thailand. Methods Model-based economic evaluations, consisting of a decision tree and a Markov model, were conducted to assess the value for money (societal perspective) and budget impact analysis (provider perspective) of endovascular treatment for acute ischemic stroke, either alone or in combination with intravenous alteplase. The methodology follows the Thai methodological and process guidelines for conducting health technology assessment. Model input parameters were collected locally from retrospective data and from a literature review of both national and international studies. In addition, number of hospitals and number of specialists in radiology/neurology were gathered from the relevant Royal Colleges. Results According to the Thai cost-effectiveness threshold of 160,000 THB per quality-adjusted life-year (QALY) gained, treatment with endovascular treatment as an adjunct therapy to intravenous alteplase for alteplase eligible-patients, and endovascular therapy alone for alteplase ineligible patients is cost-effective in treating patients with acute ischemic stroke. Adding endovascular treatment to intravenous alteplase was associated with an ICER of 147,000 THB per QALY gained compared to intravenous alteplase alone. For patients ineligiblefor intravenous alteplase, the ICER of endovascular treatment alone compared to supportive care was estimated at 114,000 THB per QALY gained. With an assumption that there will be 2,000 new cases per year, an additional budget of 887 million THB over a time horizon of 5 years would be incurred if SCBP decides to adopt endovascular therapy under the Thai health benefits package. Currently, in Thailand, there are 50 specialists in radiology and neurology, located across 52 hospitals with the capacity to provide endovascular treatment for acute ischemic stroke. However, most are located in Bangkok. Conclusions Endovascular treatment for acute ischemic stroke represents good value for money, when provided alone and when delivered with intravenous alteplase. Provision of endovascular treatment in Thailand is likely to be feasible in terms of government budget and provider capacity. Thus, endovascular treatment should be included in the Thai health benefits package, with the thrombectomy device priced between 73,800 and 88,100 THB.
