Optimal Transport System for Acute Ischemic Stroke Patients: A Cost-Effectiveness Analysis

Area of Science:

• Health Economics
• Neurology
• Health Services Research

Background:

• Acute ischemic stroke requires rapid treatment, including tissue plasminogen activator and endovascular thrombectomy.
• Optimizing patient transport is crucial for improving outcomes in stroke care.
• Geographic and logistical factors significantly influence the effectiveness of stroke treatment systems.

Purpose of the Study:

• To compare the cost-utility of four different patient transport systems for acute ischemic stroke in Hokkaido, Japan.
• To identify the most economically efficient transport strategies based on patient outcomes and treatment times.
• To inform healthcare policy regarding stroke patient management and resource allocation.

Main Methods:

• Cost utility analysis was performed on four hypothetical patient transport systems.
• Hypothetical acute ischemic stroke patients were generated using a geographic information system.
• Patient outcomes were estimated based on transport times to hospitals equipped for tissue plasminogen activator and/or endovascular thrombectomy.

Main Results:

• Transport systems involving a neurointerventionist traveling to the patient for earlier endovascular thrombectomy demonstrated superior cost-effectiveness in certain rural settings.
• Direct transportation of patients to comprehensive stroke centers proved more cost-effective in other evaluated areas.
• The optimal transport strategy varied depending on geographic factors and proximity to specialized stroke centers.

Conclusions:

• The most cost-effective strategy for acute ischemic stroke patient transport is context-dependent, varying by geographic location and available resources.
• Implementing a hybrid approach, with neurointerventionist dispatch in rural areas and direct transport to stroke centers elsewhere, may optimize resource utilization and patient outcomes.
• Further research should explore real-world implementation and long-term cost-effectiveness of these transport models.