Background
The
Melbourne Mobile Stroke Unit (MSU) is the first Australian service to
provide prehospital acute stroke treatment, including thrombolysis and
facilitated triage for endovascular thrombectomy.
Aims
To
estimate the cost-effectiveness of the MSU during the first full year
of operation compared with standard ambulance and hospital stroke care
pathways
(standard care).
(How many got 100% recovered compared to in-hospital standard care? Don't know? Then fire yourself.)
Methods
The
costs and benefits of the Melbourne MSU were estimated using an
economic simulation model. Operational costs and service utilization
data were obtained from the MSU financial and patient tracking reports.
The health benefits were estimated as disability-adjusted life years
(DALYs) avoided using local data on reperfusion therapy and estimates
from the published literature on their effectiveness. Costs were
presented in Australian dollars. The robustness of results was assessed
using multivariable (model inputs varied simultaneously: 10,000 Monte
Carlo iterations) and various one-way sensitivity analyses.
Results
In
2018, the MSU was dispatched to 1244 patients during 200 days of
operation. Overall, 167 patients were diagnosed with acute ischemic
stroke, and 58 received thrombolysis, endovascular thrombectomy, or
both. We estimated 27.94 DALYs avoided with earlier access to
endovascular thrombectomy (95% confidence interval (CI) 15.30 to 35.93)
and 16.90 DALYs avoided with improvements in access to thrombolysis (95%
CI 9.05 to 24.68). The MSU was estimated to cost an additional $30,982
per DALY avoided (95% CI $21,142 to $47,517) compared to standard care.
(How may got 100% recovered? The only goal in stroke.)
Conclusions
There
is evidence that the introduction of MSU is cost-effective when
compared with standard care due to earlier provision of reperfusion
therapies.
No comments:
Post a Comment