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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.
GLOSSARY
- CI=
- confidence interval;
- ICER=
- incremental cost-effectiveness ratio;
- IVT=
- IV thrombolysis;
- mRS=
- modified Rankin Scale;
- NNT=
- number needed to treat;
- OR=
- odds ratio;
- OTT=
- onset-to-treatment time;
- PHANTOM-S=
- Prehospital Acute Neurological Treatment and Optimization of Medical Care in Stroke;
- QALY=
- quality-adjusted life-year;
- RCT=
- randomized controlled trial;
- STEMO=
- Stroke Emergency Mobile;
- tPA=
- tissue plasminogen activator
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
- Received July 2, 2014.
- Accepted in final form November 14, 2014.
- © 2015 American Academy of Neurology
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