Joosup Kim1,2, Damien Easton3,4, Henry Zhao3,4, Skye Coote3, Garveeta Sookram1, Karen Smith4,5,6, Michael Stephenson4,5,6, Stephen Bernard4,5, Mark W Parsons3, Bernard Yan3, Patricia M Desmond7, Peter J Mitchell7, Bruce Cv Campbell2,3,4, Geoffrey A Donnan3, Stephen M Davis3, Dominique A Cadilhac1,2. 1. Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, 2541Monash University, Clayton, VIC, Australia. 2. The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia. 3. Department of Medicine and Neurology, Melbourne Brain Centre at the 90134Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia. 4. 95917Ambulance Victoria, Blackburn North, Victoria, Australia. 5. Department of Epidemiology and Preventive Medicine, 2541Monash University, Clayton, Australia. 6. Department of Paramedicine, 2541Monash University, Clayton, Australia. 7. Department of Radiology, the 90134Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia.
Abstract
BACKGROUND: The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. AIMS: To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). METHODS: The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. RESULTS: In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. CONCLUSIONS: There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.
BACKGROUND: The Melbourne Mobile Stroke Unit (MSU) is the first Australian service to provide prehospital acute stroke treatment, including thrombolysis and facilitated triage for endovascular thrombectomy. AIMS: To estimate the cost-effectiveness of the MSU during the first full year of operation compared with standard ambulance and hospital stroke care pathways (standard care). METHODS: The costs and benefits of the Melbourne MSU were estimated using an economic simulation model. Operational costs and service utilization data were obtained from the MSU financial and patient tracking reports. The health benefits were estimated as disability-adjusted life years (DALYs) avoided using local data on reperfusion therapy and estimates from the published literature on their effectiveness. Costs were presented in Australian dollars. The robustness of results was assessed using multivariable (model inputs varied simultaneously: 10,000 Monte Carlo iterations) and various one-way sensitivity analyses. RESULTS: In 2018, the MSU was dispatched to 1244 patients during 200 days of operation. Overall, 167 patients were diagnosed with acute ischemic stroke, and 58 received thrombolysis, endovascular thrombectomy, or both. We estimated 27.94 DALYs avoided with earlier access to endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93) and 16.90 DALYs avoided with improvements in access to thrombolysis (95% CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982 per DALY avoided (95% CI $21,142 to $47,517) compared to standard care. CONCLUSIONS: There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.
Entities:
Keywords:
Economic evaluation; mobile stroke unit; prehospital stroke treatment
Authors: Praveen Hariharan; Muhammad Bilal Tariq; James C Grotta; Alexandra L Czap Journal: Curr Neurol Neurosci Rep Date: 2022-02-07 Impact factor: 5.081
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