Dorte Gyrd-Hansen1, Kim Rose Olsen2, Kerstin Bollweg2, Christian Kronborg2, Martin Ebinger2, Heinrich J Audebert2. 1. From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany. dgh@sam.sdu.dk. 2. From IVØ Analysis, Department of Business and Economics (D.G.-H., K.R.O., C.K.), and Institute of Public Health (D.G.-H.), University of Southern Denmark; Department of Neurology (K.B., H.J.A.), Charité, Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin; Department of Neurology (M.E.), Charité, Universitätsmedizin Berlin, Campus Mitte, Berlin; and Center for Stroke Research Berlin (K.B., M.E., H.J.A.), Charité, Universitätsmedizin Berlin, Germany.
Abstract
OBJECTIVE: To analyze the cost-effectiveness of shorter delays to treatment and increased thrombolysis rate as shown in the PHANTOM-S (Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke) Study. METHODS: In addition to intermediate outcomes (time to thrombolysis) and treatment rates, we registered all resource consequences of the intervention. The analyzed treatment effects of the intervention were restricted to distribution of IV thrombolysis (IVT) administrations according to time intervals. Intermediate outcomes were extrapolated to final outcomes according to numbers needed to treat derived from pooled IVT trials and translated to gains in quality-adjusted life-years (QALYs). RESULTS: The net annual cost of the Stroke Emergency Mobile (STEMO) prehospital stroke concept was €963,954. The higher frequency of IVT administrations per year (310 vs 225) and higher proportions of patients treated in the early time interval (within 90 minutes: 48.1% vs 37.4%; 91-180 minutes: 37.4% vs 50%; 181-270 minutes: 14.5% vs 12.8%) resulted in an annual expected health gain of avoidance of 18 cases of disability equaling 29.7 QALYs. This produced an incremental cost-effectiveness ratio of €32,456 per QALY. CONCLUSIONS: Depending on willingness-to-pay thresholds in societal perspectives, the STEMO prehospital stroke concept has the potential of providing a reasonable innovation even in health-economic dimensions.
OBJECTIVE: To analyze the cost-effectiveness of shorter delays to treatment and increased thrombolysis rate as shown in the PHANTOM-S (Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke) Study. METHODS: In addition to intermediate outcomes (time to thrombolysis) and treatment rates, we registered all resource consequences of the intervention. The analyzed treatment effects of the intervention were restricted to distribution of IV thrombolysis (IVT) administrations according to time intervals. Intermediate outcomes were extrapolated to final outcomes according to numbers needed to treat derived from pooled IVT trials and translated to gains in quality-adjusted life-years (QALYs). RESULTS: The net annual cost of the Stroke Emergency Mobile (STEMO) prehospital stroke concept was €963,954. The higher frequency of IVT administrations per year (310 vs 225) and higher proportions of patients treated in the early time interval (within 90 minutes: 48.1% vs 37.4%; 91-180 minutes: 37.4% vs 50%; 181-270 minutes: 14.5% vs 12.8%) resulted in an annual expected health gain of avoidance of 18 cases of disability equaling 29.7 QALYs. This produced an incremental cost-effectiveness ratio of €32,456 per QALY. CONCLUSIONS: Depending on willingness-to-pay thresholds in societal perspectives, the STEMO prehospital stroke concept has the potential of providing a reasonable innovation even in health-economic dimensions.
Authors: Martin Ebinger; Bob Siegerink; Alexander Kunz; Matthias Wendt; Joachim E Weber; Eugen Schwabauer; Frederik Geisler; Erik Freitag; Julia Lange; Janina Behrens; Hebun Erdur; Ramanan Ganeshan; Thomas Liman; Jan F Scheitz; Ludwig Schlemm; Peter Harmel; Katja Zieschang; Irina Lorenz-Meyer; Ira Napierkowski; Carolin Waldschmidt; Christian H Nolte; Ulrike Grittner; Edzard Wiener; Georg Bohner; Darius G Nabavi; Ingo Schmehl; Axel Ekkernkamp; Gerhard J Jungehulsing; Bruno-Marcel Mackert; Andreas Hartmann; Jessica L Rohmann; Matthias Endres; Heinrich J Audebert Journal: JAMA Date: 2021-02-02 Impact factor: 56.272
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