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A Prospective Multicenter Analysis of Mobile Stroke Unit Cost-Effectiveness.
Suja S Rajan1, Jose-Miguel Yamal2, Mengxi Wang2
1Department of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX.
Annals of Neurology
|December 3, 2024
Summary
Mobile stroke units (MSUs) show borderline cost-effectiveness for all ischemic stroke patients initially. However, MSUs become highly cost-effective for patients without prior disability, considering lifetime costs and stroke-related expenses.
Area of Science:
- Neurology
- Health Economics
- Emergency Medical Services
Background:
- Ischemic stroke presents a significant disease and financial burden.
- Timely administration of thrombolytics is crucial for effective stroke management.
- Evaluating novel approaches like Mobile Stroke Units (MSUs) for stroke treatment is critical.
Purpose of the Study:
- To evaluate the cost-effectiveness of Mobile Stroke Units (MSUs) compared to standard Emergency Medical Services (EMS) for expediting tissue plasminogen activator (tPA) administration.
- To analyze one-year and lifetime cost-effectiveness using the Incremental Cost-Effectiveness Ratio (ICER) method.
Main Methods:
- A prospective, multicenter, alternating-week, cluster-controlled trial comparing MSU and EMS.
- Quality-adjusted life years (QALYs) estimated via EQ-5D-5L data served as the primary effectiveness measure.
- Cost analysis based on Medicare reimbursements, including calculations excluding pre-existing disability and limited to stroke-related costs.
Main Results:
- First-year ICERs were $238,873/QALY for all tPA-eligible patients and $61,199/QALY for those without pre-existing disability.
- Lifetime ICERs were $94,710/QALY for all patients and $31,259/QALY for those without pre-existing disability.
- ICERs decreased when restricted to stroke-related costs and were influenced by annual patient treatment volume per MSU.
Conclusions:
- MSUs demonstrate borderline cost-effectiveness for all tPA-eligible patients within the first year, considering total costs.
- MSUs are cost-effective to highly cost-effective for patients without pre-existing disability, over a lifetime horizon, and when focusing on stroke-related costs.
- The cost-effectiveness of MSUs is significantly dependent on patient volume and specific cost parameters.
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