Case costing of mechanical thrombectomy for acute ischaemic stroke in routine clinical setting: cost differences between mothership vs drip and ship

Introduction: Data is limited on the additional costs associated with delivering mechanical thrombectomy (MT) to patients admitted first to a non-thrombectomy centre. We examined the cost differences between delivering MT in the mothership (MS) with the drip-and-ship (DS) model of care. Methods: A micro-costing approach was utilised with resource-use and unit-costs identified from pre-hospital-transportation (PHT) up to 24-hours post-MT. Results: 80 patients underwent MT (MS 40, DS 40) from 3 UK MT centres. The average 24-hour costs of MT was £7,716 (SD £2,525) for MS and £8,178 (SD £2,028) for DS, mean difference −£462 in favour of MS; (95% CI −£1,483 to £558) p = 0.05. There was a nonsignificant difference in PHT costs: MS = £194 (SD £45) vs DS = £411(SD 12), p = 0.16. There was a significant difference between MS and DS in emergency-hospital-attendance (EHA) costs: £428 (£84) vs £517 (SD £197) p < 0.001 and in imaging costs: £376 (SD £130) vs £689 (SD £164) p < 0.001. No significant difference in procedural costs: MS = £6119 (SD £2,383) vs DS = £5940 (SD £1,983), p = 0.07 or 24-hour hospital admission: MS = £602 (SD £451) vs DS = £574 (SD £399), p = 0.54. Conclusion: Our micro-costing finds no significant difference between MS and DS in the average cost of providing MT. Some differences favouring MS were observed for EHA and imaging costs due to repeat EHA and CT scans. Estimates based on observed patient treatment pathways highlight the main components of cost and sources of variance. The findings merit validation in larger samples, but will be valuable to researchers and service planners.