Cost-effectiveness of the ABCStroke pathway in ischaemic stroke care: a UK pilot analysis

Aims The ABC(Stroke) pathway is a structured, person-centred approach to post-stroke care encompassing antithrombotic therapy, functional and psychological optimization, and cardiovascular risk factor management, proposed by the European Society of Cardiology Council on Stroke. Adherence to the pathway has been associated with improved outcomes in observational studies, but its cost-effectiveness remains unknown. We evaluated the long-term cost-effectiveness of the ABC(Stroke) pathway in the UK. Methods and results A Markov model was developed to simulate lifetime costs and outcomes of patients following an ischaemic stroke, using clinical data from the Athens Stroke Registry and UK-specific cost and utility inputs from the Oxford Vascular Study. Patients were stratified by adherence to all three ABC(Stroke) pathway components vs. non-adherence. Over a 20-year horizon, pathway-aligned/adherent care was associated with higher costs (129 pound 143 vs. 71 pound 472) and greater quality-adjusted life years (QALYs; 9.84 vs. 5.94), yielding an incremental cost-effectiveness ratio (ICER) of 14 pound 804 per QALY gained. At a willingness-to-pay threshold of 25 pound 000 per QALY, the net monetary benefit of the ABC(Stroke) pathway was 116,857 pound, compared with 77 pound 028 for non-aligned care, indicating a net gain of 39 pound 829 in favour of the ABC-aligned strategy. Deterministic sensitivity analyses showed the ICER remained below 16 pound 000 per QALY across plausible parameter ranges. Even assuming a 100-fold increase in pathway implementation costs, the strategy remained within or near the lower boundary of the UK National Institute for Health and Care Excellence willingness-to-pay threshold. Conclusion In the UK, implementation of the ABC(Stroke) pathway is cost-effective. These findings support strategic investment in structured, multidisciplinary integrated care for stroke survivors.