A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischaemic stroke

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). 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. Conclusions There is evidence that the introduction of MSU is cost-effective when compared with standard care due to earlier provision of reperfusion therapies.

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“…For example, the provision of thrombolysis and EVT appears to be more cost-effective when considering downstream costs in the longer term. 26–28…”

Section: Discussionmentioning

confidence: 99%

Economic evaluation of the Melbourne Mobile Stroke Unit

Kim

Easton

Zhao

et al. 2020

International Journal of Stroke

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“…Although lack of resources is often perceived as a barrier to Open access system change, 53 we demonstrated that much can be accomplished through reorganisation of existing services. We did not conduct a cost analysis, but other studies have demonstrated the cost-effectiveness of thrombolytic therapy, 54 and it has been estimated that optimising comprehensive stroke care in Canada could avoid costs of $682 million annually. 55…”

Section: Discussionmentioning

confidence: 99%

Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years

et al. 2021

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Stroke is a complex disorder that challenges healthcare systems. An audit of in-hospital stroke care in the province of Nova Scotia, Canada, in 2004–2005 indicated that many aspects of care delivery fell short of national best practice recommendations. Stroke care in Nova Scotia was reorganised using a combination of interventions to facilitate systems change and quality improvement. The focus was mainly on implementing evidence-based stroke unit care, augmenting thrombolytic therapy and enhancing dysphagia assessment. Key were the development of a provincial network to facilitate ongoing collaboration and structured information exchange, the creation of the stroke coordinator and stroke physician champion roles, and the implementation of a registry to capture information about adults hospitalised because of stroke or transient ischaemic attack. To evaluate the interventions, a longitudinal analysis compared the audit results with registry data for 2012, 2015 and 2019. The proportion of patients receiving multidisciplinary stroke unit care rose from 22.4% in 2005 to 74.0% in 2019. The proportion of patients who received alteplase increased steadily from 3.2% to 18.5%, and the median delay between hospital arrival and alteplase administration decreased from 102 min to 56 min, without an increase in intracranial haemorrhage. Dysphagia screening increased from 41.4% to 77.4%. More patients were transferred from acute care to a dedicated in-patient rehabilitation unit, and fewer were discharged to residential or long-term care. These enhancements did not prolong length-of-stay in acute care. The network was a critical success factor; competing priorities in the healthcare system were the main challenge to implementing change. A multidimensional, multiyear, improvement intervention yielded substantial and sustained improvements in the process and structure of stroke care in Nova Scotia.

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“…These two advanced therapies have been shown to lead to reduced mortality and improved functional outcomes of ischemic stroke patients [32,33], which can shorten the length of hospital stay [34,35]. Despite higher costs in the acute phase, thrombolysis and endovascular thrombectomy have been established to be cost-effective [36,37]. Intravenous thrombolysis and endovascular therapies are, however, unsuitable for many stroke patients; a recent survey showed that in Finland, 12.6% of stroke patients received intravenous and only 3.6% endovascular treatment [38].…”

Section: Discussionmentioning

confidence: 99%

Costs structure of the inpatient ischemic stroke treatment using an exact costing method

Puumalainen

Elonheimo

Brommels

2020

Heliyon

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Most stroke care expenses are inhospital costs. Given the previously reported inaccuracy of conventional costing, the purpose of this study was to provide an accurate analysis of inpatient costs of stroke care in an acute care hospital. Materials and methods: We used activity-based costing (ABC) for calculating the costs of ischemic stroke patients. We collected the activity data at the Helsinki University Central Hospital. Persons involved in patient care logged their activities on survey forms for one week. The costs of activities were calculated based on information about salaries, material prices, and other costs obtained from hospital accounting data. We calculated costs per inpatient days and episodes, analyzed cost structure, made a distinction in cost for stroke subtypes according to the Oxford and TOAST classification schemes, and compared cost per inpatient episode with the diagnoses-related group (DRG) -price of the hospital. Results: The sample comprised 196 inpatient days of 41 patients. By using the ABC, the mean and median costs of an inpatient day were 346 € and 268 €, and of an inpatient episode 3322 € and 2573 €, respectively. Average costs differed considerably by stroke subtype. The first inpatient day was the most expensive. Working time costs comprised 63% of the average inpatient day cost, with nursing constituting the largest proportion. The mean cost of an inpatient episode was 21% lower with ABC than with DRG pricing. Conclusion:We demonstrate that there are differences in cost estimates depending on the methods used. ABC revealed differences among patients having the same diagnosis. The cost of an episode was lower than the DRG price of the hospital. Choosing an optimal costing method is essential for both reimbursements of hospitals and health policy decision-making.

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A literature review of cost-effectiveness of intravenous recombinant tissue plasminogen activator for treating acute ischaemic stroke

Cited by 26 publications

References 34 publications

Economic evaluation of the Melbourne Mobile Stroke Unit

Economic evaluation of the Melbourne Mobile Stroke Unit

Improving stroke care in Nova Scotia, Canada: a population-based project spanning 14 years

Costs structure of the inpatient ischemic stroke treatment using an exact costing method

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