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. 2020 Feb 12:10:1422.
doi: 10.3389/fneur.2019.01422. eCollection 2019.

Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport

Andrew P Reimer  1   2 , Atif Zafar  3 , Fredric M Hustey  1 , Damon Kralovic  1 , Andrew N Russman  3 , Ken Uchino  3 , Muhammad S Hussain  3 , Belinda L Udeh  4   5
Affiliations

Cost-Consequence Analysis of Mobile Stroke Units vs. Standard Prehospital Care and Transport

Andrew P Reimer et al. Front Neurol. .

Abstract

Background: Mobile stroke units (MSUs) are the latest approach to improving time-sensitive stroke care delivery. Currently, there are no published studies looking at the expanded value of the MSU to diagnose and transport patients to the closest most appropriate facility. The purpose of this paper is to perform a cost consequence analysis of standard transport (ST) vs. MSU. Methods and Results: A cost consequence analysis was undertaken within a decision framework to compare the incremental cost of care for patients with confirmed stroke that were served by the MSU vs. their simulated care had they been served by standard emergency medical services between July 2014 and October 2015. At baseline values, the incremental cost between MSU and ST was $70,613 ($856,482 vs. $785,869) for 355 patient transports. The MSU avoided 76 secondary interhospital transfers and 76 emergency department (ED) encounters. Sensitivity analysis identified six variables that had measurable impact on the model's variability and a threshold value at which MSU becomes the optimal strategy: number of stroke patients (>391), probability of requiring transfer to a comprehensive stroke center (CSC, >0.52), annual cost of MSU operations (<$696,053), cost of air transfer (>$8,841), probability initial receiving hospital is a CSC (<0.32), and probability of ischemic stroke with ST (<0.76). Conclusions: MSUs can avert significant costs in the administration of stroke care once optimal thresholds are achieved. A comprehensive cost-effectiveness analysis is required to determine not just the operational value of an MSU but also its clinical value to patients and the society.

Keywords: cost analysis; mobile stroke treatment unit; prehospital emergency care; stroke; transportation of patients.

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Figures

Figure 1
Figure 1
Skeleton decision tree.
Figure 2
Figure 2
Patient flow diagram.
Figure 3
Figure 3
Monte Carlo probability distribution of MSU point of cost neutrality.
See this image and copyright information in PMC

References

    1. Prabhakaran S, Ward E, John S, Lopes DK, Chen M, Temes RE, et al. . Transfer delay is a major factor limiting the use of intra-arterial treatment in acute ischemic stroke. Stroke. (2011) 42:1626–30. 10.1161/STROKEAHA.110.609750 - DOI - PubMed
    1. Emberson J, Lees KR, Lyden P, Blackwell L, Albers G, Bluhmki E, et al. . Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials. Lancet. (2014) 384:1929–35. 10.1016/S0140-6736(14)60584-5 - DOI - PMC - PubMed
    1. Kim DH, Bae HJ, Han MK, Kim BJ, Park SS, Park TH, et al. . Direct admission to stroke centers reduces treatment delay and improves clinical outcome after intravenous thrombolysis. J Clin Neurosci. (2016) 27:74–9. 10.1016/j.jocn.2015.06.038 - DOI - PubMed
    1. Walter S, Kostopoulos P, Haass A, Keller I, Lesmeister M, Schlechtriemen T, et al. Diagnosis and treatment of patients with stroke in a mobile stroke unit vs. in hospital: a randomised controlled trial. Lancet Neurol. (2012) 11:397–404. 10.1016/S1474-4422(12)70057-1 - DOI - PubMed
    1. Dietrich M, Walter S, Ragoschke-Schumm A, Helwig S, Levine S, Balucani C, et al. . Is prehospital treatment of acute stroke too expensive? An economic evaluation based on the first trial. Cerebrovasc Dis. (2014) 38:457–63. 10.1159/000371427 - DOI - PubMed

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