Deans' stroke musings: A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Wednesday, July 9, 2025

A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.

Stroke survivors don't care about 'cost'. They want to know 100% RECOVERY EFFECTIVENESS! Are you that blitheringly stupid?

A Decision-Analytic Model to Evaluate Cost-Effectiveness of Regional Implementation of a Mobile Stroke Unit.

Peter L van Hulst, Ruben M van de Wijdeven, Esmee Venema, Florentina M E Pinckaers

Neurology. 2025 Aug 12; 105(3):

BACKGROUND AND OBJECTIVES

Mobile stroke units (MSUs) have the potential to improve functional outcome of ischemic stroke patients, through shortening onset-to-treatment times. Previous cost-effectiveness studies have limited generalizability to nonmetropolitan settings and did not evaluate cost-effectiveness over a lifetime horizon. We aimed to develop a regionally adaptable decision-analytic model, to evaluate cost-effectiveness of MSU implementation and to identify the optimal dispatch scenario.

METHODS

We developed a generalizable state-transition microsimulation model with modifiable region-specific parameters and dispatch characteristics to evaluate the lifetime cost-effectiveness from a health care perspective of 1-year MSU implementation. We used the southwest of the Netherlands (1,770,000 inhabitants, 1,592 km², 7 primary stroke centers, 2 thrombectomy-capable stroke centers) as an example. Region-specific input parameters for the model, such as population density, age distribution, and driving times, were obtained at the level of postal codes. We developed a virtual cohort of suspected stroke patients based on age-dependent stroke risks and the number of inhabitants per postal code. We compared the combined dispatch of an MSU and emergency medical services (EMS) with dispatch of EMS alone for patients with onset-to-alarm time <6 hours, living within the catchment area of the MSU. In the base case analysis, the MSU could be dispatched to all postal codes in the study region between 7.00 am and 11.00 pm from a central dispatch site. We assessed the long-term cost-effectiveness through incremental net monetary benefits (iNMBs). Discount rates were 1.5% for effects and 4.0% for costs.

RESULTS

In the base case scenario, the MSU was dispatched to 2,080 of 3,628 patients (57.3%) with a suspected stroke and onset-to-alarm time <6 hours, resulting in a lifetime gain of 399 (95% CI 384-414) additional quality-adjusted life years, €3.9 million (95% CI €3.5 million-€4.3 million) cost savings, and an iNMB of €23.9 million (95% CI €22.8 million-€24.9 million). A smaller catchment area for MSU dispatch was associated with increased cost-effectiveness.

DISCUSSION

Adding an MSU to the dispatch strategy for suspected stroke patients is expected to be cost-effective in our region. Our model facilitates evaluation of the cost-effectiveness of MSU implementation in different regions, settings, and scenarios with varying characteristics.

Source: Neurology