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Controlled Clinical Trial
. 2025 Feb;97(2):209-221.
doi: 10.1002/ana.27105. Epub 2024 Dec 3.

A Prospective Multicenter Analysis of Mobile Stroke Unit Cost-Effectiveness

Suja S Rajan  1 , Jose-Miguel Yamal  2 , Mengxi Wang  2 , Jeffrey L Saver  3 , Asha P Jacob  4 , Nicole R Gonzales  5 , Nneka Ifejika  6   7 , Stephanie A Parker  8 , Christopher Ganey  1 , Michael O Gonzalez  2 , David R Lairson  1 , Patti L Bratina  8 , William J Jones  5 , Jason S Mackey  9 , Mackenzie P Lerario  10 , Babak B Navi  10 , Ann W Alexandrov  11 , Andrei Alexandrov  12 , May Nour  3   13 , Ilana Spokoyny  14 , Ritvij Bowry  4 , Alexandra L Czap  4 , James C Grotta  8
Affiliations
Controlled Clinical Trial

A Prospective Multicenter Analysis of Mobile Stroke Unit Cost-Effectiveness

Suja S Rajan et al. Ann Neurol. 2025 Feb.

Abstract

Objective: Given the high disease and cost burden of ischemic stroke, evaluating the clinical efficacy and cost-effectiveness of new approaches to prevent and treat ischemic stroke is critical. Effective ischemic stroke management depends on timely administration of thrombolytics after stroke onset. This study evaluates the cost-effectiveness associated with the use of mobile stroke units (MSUs) to expedite tissue plasminogen activator (tPA) administration, as compared with standard management through emergency medical services (EMS).

Methods: This study is a prospective, multicenter, alternating-week, cluster-controlled trial of MSU versus EMS. One-year and life-time cost-effectiveness analyses, using the incremental cost-effectiveness ratio (ICER) method, were performed from the perspective of CMS's Medicare. Quality-adjusted life years (QALYs) estimated using patient-reported EQ-5D-5L data were used as the effectiveness measure. Health care utilizations were converted to costs using average national Medicare reimbursements. ICERs excluding patients with pre-existing disability, and limited to stroke-related costs were also calculated.

Results: The first-year ICER for all tPA-eligible patients using total cost differences between MSU and EMS groups was $238,873/QALY; for patients without pre-existing disability was $61,199/QALY. The lifetime ICERs for all tPA-eligible patients and for those without pre-existing disability were $94,710 and $31,259/QALY, respectively. All ICERs were lower when restricted to stroke-related costs and were highly dependent on the number of patients treated per year in an MSU.

Interpretation: MSUs' cost-effectiveness is borderline if we consider total first-year costs and outcomes in all tPA-eligible patients. MSUs are cost-effective to highly cost-effective when calculations are based on patients without pre-existing disability, patients' lifetime horizon, stroke-related costs, and more patients treated per year in an MSU. ANN NEUROL 2025;97:209-221.

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